ORIGINAL ARTICLE

The "bench-presser’s shoulder": an overuse insertional tendinopathy of the pectoralis minor muscle

Deepak N Bhatia¹, Joe F de Beer¹, Karin S van Rooyen¹, Francis Lam¹, Donald F du Toit²

¹ Cape Shoulder Institute, Plattekloof, Cape Town, South Africa
² Department of Anatomy, University of Stellenbosch, Plattekloof, Cape Town, South Africa

Correspondence to:
Dr D N Bhatia
Cape Shoulder Institute, Suite no 4, Medgroup Anlin House, 43 Bloulelie Crescent, Plattekloof, Cape Town, South Africa;thebonesmith{at}gmail.com

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.

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Bench-presser’s shoulder – a question of neovascularisation

Karsten Knobloch, et al.

BJSM Online, 22 Jan 2007 [Full text]