UPON REVIEW IN
CONJUNCTION WITH A BOARD CERTIFIED ORTHOPAEDIC SURGEON:
Optimal treatment of an acute pectoralis muscle rupture is surgical; the
injury can heal by secondary intention (fibrosis, scarification) with less
optimal function with regard to strength. To
ensure the greatest chance for the best outcome, surgery needs to be performed
within 3-4 weeks, and as a consequence the injury must be properly diagnosed
clinically and/or in conjunction with diagnostic imaging either by the initial
treating physician, consultation with an orthopaedic surgeon and/or suggestion
by a radiologist.
Subsequent to the 3-4 week post injury period the potential for surgical
treatment with optimal recovery diminishes as tissues, including any remaining
tendon, become more friable due to the progressive inflammatory process.
As any chance to improve physical function (adduction) would require
surgical treatment, though conservative treatment would lead to progressive
scarification with anticipated less than optimal functional capacity with regard
to adduction, ongoing delay, presumably because of the need for authorization
through Workers' Compensation, would progressively diminish chances for the most
profitable functional outcome.
Subsequent to surgical treatment (done at any time) requires extremely
close supervision for the first four weeks with regard to movement of the upper
extremity which may lead to recurrent rupture, i.e., the upper extremity should
remain immobilized; this may require a plaster wrap or strict instructions not
to remove the immobilizer in order to facilitate post-operative scarification. Should physical therapy begin earlier, the physical therapist
should have precise instructions with regard to avoiding any potential movement
which might lead to recurrent rupture.
Preexisting conditions may have had a mild effect on the patient’s
condition, and the patient may also have sustained an additional injury to the
cervical spine which was undiagnosed prior to surgical treatment.
The preexisting
healed compound forearm fracture of the left arm with residual inability to
extend fingers in conjunction with an additional injury to the cervical spine
was not fully diagnosed prior to treatment of the ruptured pectoralis major
muscle.
Preexisting
degenerative arthritis of the cervical spine and modification of pain from the
primary injury may have caused manifestations of pain in the neck and numbness
in the left upper extremity to become more symptomatic.
CONCLUSION:
By the above criteria,
The patient's left pectoralis
Delay in surgical treatment subsequent to the eventual decision for
surgical treatment as the only option, albeit small, for the most effective
optimal recovery of physical functional (adduction) was presumably prolonged as
a consequence of bureaucratic decision making within the Workers' Compensation
system.
As
post operative management within the first four weeks is critical, strict
supervision of the patient's movement prior to adequate post-operative
scarification is essential to avoid the potential for post-operative rupture,
and should this attention not be available, the patient should have absolute
instructions not to remove the shoulder immobilizer, and/or a plaster wrapping
should be applied.
Moreover,
the patient's preexisting residual physical restrictons as a consequence of a
compound left forearm fracture may have an additional mild effect on forces
applied to the healing site as well as the development of manifestations of
numbness in the left arm which also may have developed in conjunction with a
concurrent injury to the cervical spine, symptoms of which may have become more
prominent subsequent to surgical treatment and rehabilitation.
THE
HEALTH PLACE
A Private Medical Practice of David P. Kalin, M.D., M.P.H.
P.O. Box 6009
Palm Harbor, Fl 34684
Tel 813.966.1431 Fax
813.925.1932
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