The "Bench-presser’s Shoulder": An overuse insertional tendinopathy of the pectoralis minor muscle

Deepak N. Bhatia ^1*, Joe F. de Beer ¹, Karin S vanRooyen ¹, Francis Lam ¹ and Donald F. duToit ²

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

^* To whom correspondence should be addressed. E-mail: thebonesmith{at}gmail.com.

Accepted 29 October 2006

Abstract

Tendinopathies of the rotator cuff muscles, biceps tendon and pectoralis major muscle are common causes of shoulder pain in athletes. We describe the clinical features and diagnostic tests of an overuse insertional tendinopathy of the pectoralis minor muscle. A new technique of ultrasonographic evaluation and injection of the pectoralis minor muscle/tendon is presented; the technique is based on utilization of standard anatomic landmarks (subscapularis, coracoid process, axillary artery) as stepwise reference points for ultrasonographic orientation. Between 2005 and 2006, we diagnosed and treated seven sportsmen presenting with this condition. 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 maneuver, and decrease in pain after ultrasound-guided injection of a local anesthetic agent into the enthesis, in 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.

Key Words: Bench-press, overuse insertional tendinopathy, pectoralis minor, sports injury, ultrasound-guided injection

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