Page 29 - Journal of Special Operations Medicine - Fall 2016

Pectoralis Major Injury During Basic Airborne Training

When the Sean McIntire, MD; Lee Boujie, SO-IDC; John Leasiolagi, SO-IDC

safe house ABSTRACT major injury while exiting an aircraft during the Basic

Injuries involving rupture of the pectoralis major are rel-
becomes atively rare. When they do occur, it is mostly frequently Airborne Course.
in a young, athletic man. The most common cause is
weight lifting that results in eccentric muscle contrac-
Case Presentation
tion (muscle contraction against an overbearing force,
an icu leading to muscle lengthening)—specifically, the bench A 29-year-old, right-hand dominant, male Reconnais-
press. Other mechanisms for this injury include forceful
sance Marine presented during sick call to the battalion
aid station (BAS), with left anterior shoulder pain for
abduction and external rotation of the arm. Injury can
occur anywhere along the pectoralis major from its me-
1 week. The Marine had attended the Basic Airborne
dial origin on the sternum and clavicle to its lateral ten-
dinous insertion on the humerus. At the time of injury, Course the week before at Fort Benning, Georgia. Dur-
ing his second training jump, his left arm became entan-
patients may report feeling a tearing sensation or hear- gled in his static line as he exited the aircraft, forcefully
ing a pop, with immediate onset of pain. Physical exam- abducting and externally rotating the arm. When his
IA MED specializes in military unit ination findings can include a deformed appearance of parachute deployed and he became stable in his descent,
the chest, ecchymosis of the chest and upper arm, pain he became aware of immediate pain in his anterior
and government agency training. and weakness with arm adduction and internal rotation, shoulder. He denied hearing or feeling a popping sen-
or noticeable asymmetry of the anterior axilla with arm sation. He landed safely and was able to complete the
abduction. Magnetic resonance imaging is the imaging remaining jumps required to graduate from training.
study of choice to aid diagnosis. In a young and active
population, such as the Special Operations community, In the days following his injury, he noted bruising over his
appropriate and timely diagnosis is important because medial left arm, pain with internal rotation, along with
surgical intervention often is recommended. This report a slight deformity in the musculature of his left chest.
presents the case of an active-duty Servicemember who The patient attempted to address his pain with over-the-
sustained a pectoralis major injury while exiting an air- counter ibuprofen and acetaminophen, with minimal re-
craft during the Basic Airborne Course. lief. He had no significant medical or surgical history,
and did not use tobacco products. Focused musculoskel-
Keywords: pectoralis major; rupture; avulsion; tear; airborne; etal examination demonstrated asymmetry of the ante-
parachute; static line rior left chest wall and axilla compared with the right,
as well as ecchymosis over the medial portion of the left
arm. Tenderness to palpation was present over the proxi-
mal medial humerus and axilla. Elevation of the arm in
Introduction any plane elicited pain. Arm adduction against resistance
2017 Course Offering Injuries involving rupture of the pectoralis major are rel- revealed a visible and palpable defect in the pectoralis
atively rare. When they do occur it is mostly frequently major. The patient had no vascular impairment, neuro-
in a young, athletic man. The most common cause is logical deficits, or other significant findings on physical
weight lifting that results in eccentric muscle contraction examination. Radiographs of the left shoulder and hu-
Austere Critical Care Lab (muscle contraction against an overbearing force, lead- merus were unremarkable. Magnetic resonance imaging
ATP to NRP Bridge Course ing to muscle lengthening), specifically the bench press. (MRI) of the chest without contrast was then performed,
Flight Paramedic (FP-C) Other mechanisms for this injury include forceful ab- which revealed a high-grade tear of the pectoralis major
at the musculotendinous junction (Figure 1).
duction and external rotation of the arm. It is important
Critical Care Paramedic (CCP-C) to recognize pectoralis major injury expeditiously, as
Tactical Paramedic (TP-C) surgical intervention is often recommended for our ac- Anatomy
NAEMT TCCC/TECC tive duty population. The authors present the case of an The pectoralis major muscle functions as a forceful ad-
IAMED.uS active duty Servicemember who sustained a pectoralis ductor, internal rotator, and forward flexor of the arm.

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