The "bench-presser's shoulder": an overuse insertional tendinopathy of the pectoralis minor muscle. Issue 8 (30th November 2006)

• Record Type: Journal Article
• Authors: Bhatia, Deepak N; de Beer, Joe F; van Rooyen, Karin S; Lam, Francis; du Toit, Donald F
• Is Part Of: British journal of sports medicine. Volume 41:Issue 8(2007)
• Page Start: e11
• Page End: e11
• Publication Date: 2006-11-30
• Subjects: Sports medicine -- Periodicals; 617.1027
• DOI: 10.1136/bjsm.2006.032383
• Languages: English
• ISSNs: 0306-3674

Abstract

Abstract : Background: Tendinopathies of the rotator cuff muscles, biceps tendon and pectoralis major muscle are common causes of shoulder pain in athletes. Overuse insertional tendinopathy of pectoralis minor is a previously undescribed cause of shoulder pain in weightlifters/sportsmen. Objectives: To describe the clinical features, diagnostic tests and results of an overuse insertional tendinopathy of the pectoralis minor muscle. To also present a new technique of ultrasonographic evaluation and injection of the pectoralis minor muscle/tendon based on use of standard anatomical landmarks (subscapularis, coracoid process and axillary artery) as stepwise reference points for ultrasonographic orientation. Methods: Between 2005 and 2006, seven sportsmen presenting with this condition were diagnosed and treated at the Cape Shoulder Institute, Cape Town, South Africa. Results: In five patients, the initiating and aggravating factor was performance of the bench-press exercise (hence the term "bench-presser's shoulder"). Medial juxta-coracoid tenderness, a painful active-contraction test and bench-press manoeuvre, and decrease in pain after ultrasound-guided injection of a local anaesthetic agent into the enthesis, in the absence of any other clinically/radiologically apparent pathology, were diagnostic of pectoralis minor insertional tendinopathy. All seven patients were successfully treated with a single ultrasound-guided injection of a corticosteroid into the enthesis of pectoralis minor followed by a period of rest and stretching exercises. Conclusions: This study describes the clinical features and management of pectoralis minor insertional tendinopathy, secondary to the bench-press type of weightlifting. A new pain site-based classification of shoulder pathology in weightlifters is suggested.