12:45

Repair of Pectoralis major muscle using Arthrex Pec Buttons surgical technique

Overview

Subscribe to get full access to this operation and the extensive Shoulder & Elbow Surgery Atlas.

SUBSCRIBE


Learn the Repair of Pectoralis major muscle using Arthrex Pec Buttons surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Repair of Pectoralis major muscle using Arthrex Pec Buttons surgical procedure.

The pectoralis major muscle is a fan shaped muscle the sits on the anterior aspect of the chest wall. It arises from the anterior surface of the sternal half of the clavicle, the anterior half of the sternum to the costal cartilages of the first six ribs and the aponeurosis of the external oblique muscle. As the muscle fibres converge towards its insertion on the proximal humerus, they form two distinctive insertions. The clavicular head fibres run obliquely inferiorly and laterally and inserts superficially. The sternal head fibres run more horizontally, whereas the inferior fibres run obliquely superiorly and laterally. The more inferior fibres tend to twist up and insert deeper and more superiorly on the proximal humerus. The fibres end up in a flat tendon around 5cm in diameter and insert into the lateral lip of the bicipital groove of the humerus.

The main muscle actions of pectoralis major include flexion, adduction, internal rotation and extension (from a flexed position) of the humerus. It also acts as a dynamic stabiliser of the shoulder.

Pectoralis major ruptures occur when there is an excessive tension acting on a maximally eccentrically contracted muscle, such as during a bench press. Pectoralis major ruptures can either occur as a tendinous avulsion (most common), or rupture at the musculotendinous junction or within the muscle substance itself.

Ruptures of pectoralis major are rare but largely effect athletic populations, particularly weight-lifters. It predominantly affects males due to larger tendon to muscle ratio, greater elasticity and less energetic injuries occurring in males. This can result in weakness, pain and cramping.

A very useful implant for the fixation of these rare injuries, and my preference, is using the Arthrex Large Pec Button Kit. This consists of a 3.7mm drill pin, 3 large Pec buttons with inserters, 2mm Fibretape x3 and number 5 Fibrewire x3. I prefer to use a Krakow stitch using the Fibretape in the ruptured pectoralis major tendon as it has better pullout characteristics due to the larger surface area of the tape. Two or three Pec buttons provide a robust fixation spread over a large area and restore the anatomy of the insertion of pectoralis major.

Author: Mr Samuel Chan FRCS (Tr & Orth).

Institution: The Queen Elizabeth Hospital, Birmingham, UK.

Feedback

  • Each operation and the questions associated become named course in the CPD section
  • The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
  • You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
  • The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
  • There are four possible answers of which one is correct (or on occasion more correct) than the others.
  • There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
  • The course is completed once all the lessons are read and quizzes submitted and passed.
  • On successful completion of each quiz you will receive a validated certificate in your CPD folder.
  • Your dashboard also will contain a record of the time you have spent logged onto and using the site.
  • The timer suspends after 5 minutes though if there is no activity.
  • When you restart you will resume at the same point in the module.
  • Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
    The pass mark is 75%.
  • If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
  • Once these have been read you can re-do just the questions you failed on.
  • Once you have passed the quiz you can return at a future stage & resit .
Continue to Course Content

COURSE

Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.

Our content is designed for both Surgeons in independent practice and Surgeons in training.

COURSE PROGRESS

Lessons Status
QuizzesStatus

Accreditations

Logo Logo Logo Logo

Associates & Partners

Logo Logo Logo Logo Logo