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MR Imaging Assessment of the Pectoralis Major Myotendinous Unit

An MR Imaging—Anatomic Correlative Study with Surgical Correlation

Josephine Lee1, Keith R. Brookenthal2, Matthew L. Ramsey2, J. Bruce Kneeland1 and Richard Herzog1

1 Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.
2 Department of Orthopaedics, Hospital of the University of Pennsylvania, Philadelphia, PA 19104.



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  		Fig. 1A. —Insertion of pectoralis major tendon in lateral lip of intertubercular groove. T1-weighted MR image of 80-year-old male cadaver obtained with gadolinium markers reveals the thick marker (arrowhead) at the myotendinous junction as defined by orthopedic surgeon. Thin marker (arrow) lies along the insertion of tendon.

 


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  		Fig. 1B. —Insertion of pectoralis major tendon in lateral lip of intertubercular groove. Corresponding proton density-weighted MR image of 29-year-old athletic healthy male volunteer shows normal tendon insertion (arrow) and myotendinous junction (arrowhead).

 


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  		Fig. 2A. —Relationship of the pectoralis major tendon to surrounding anatomic landmarks. T1-weighted axial MR imaging of male cadaver obtained with thin gadolinium marker (arrow) along tendon insertion reveals superior aspect of pectoralis major tendon and its relationship to quadrilateral space (QL).

 


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  		Fig. 2B. —Relationship of the pectoralis major tendon to surrounding anatomic landmarks. Corresponding proton density-weighted MR image in healthy male volunteer shows relationship of normal tendon insertion (arrow) and quadrilateral space (QL).

 


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  		Fig. 2C. —Relationship of the pectoralis major tendon to surrounding anatomic landmarks. T1-weighted axial MR image of same male cadaver obtained with thin gadolinium marker (arrow) reveals superior aspect of tendon insertion and its relationship to origin of lateral head of triceps (T).

 


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  		Fig. 2D. —Relationship of the pectoralis major tendon to surrounding anatomic landmarks. Corresponding proton density-weighted image in healthy male volunteer shows normal tendon of insertion (arrow) and its relationship to origin of lateral head of triceps (T).

 


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  		Fig. 2E. —Relationship of the pectoralis major tendon to surrounding anatomic landmarks. T1-weighted axial MR image of male cadaver obtained with gadolinium marker (arrow) reveals relationship of inferior aspect of tendon to deltoid tuberosity (arrowhead).

 


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  		Fig. 3. —40-year-old man with sudden severe pain while bench-pressing. T2-weighted axial MR image reveals complete disruption of pectoralis major tendon at its insertion (arrow) with retraction of muscle belly medially (black arrows). Note marked edema along leading edge of torn muscle.

 


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  		Fig. 4. —36-year-old man with pain while bench-pressing. T2-weighted axial MR image reveals complete rupture of pectoralis major tendon at its insertion (arrow) with retraction of muscle belly medially (thick arrows) and displacement of biceps tendon (B) from intertubercular groove. Note abnormally increased fluid within intertubercular groove.

 


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  		Fig. 5A. —25-year-old man with sudden pain and weakness while wrestling. Proton density-weighted axial MR image reveals complete tear of pectoralis major muscle at myotendinous junction with retraction of muscle belly (arrowheads) and intact clavicular head of insertion (arrow).

 


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  		Fig. 5B. —25-year-old man with sudden pain and weakness while wrestling. Corresponding T2-weighted MR image at same levels as A reveals marked intramuscular edema at injury site (arrows).

 


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  		Fig. 6. —Anatomic drawing with deltoid muscle retracted shows normal anatomy of pectoralis major and its insertion in humeral head. Note 180° twist of three laminae before insertion.

 

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