Cervical Injections
Jean Carruthrs, Alastair Carruthrs in Using Botulinum Toxins Cosmetically, 2003
The platysmal muscle is a large muscle, which inserts into the pectoralis major and minor along the thoracic inlet and extends vertically up the neck to interdigitate with the lower muscles of facial expression. As with horizontal ‘necklace’ lines, the vertical platysmal bands are external to the muscles of deglutition, speech and neck flexion. The simplest approach is to inject 1–2 U of BOTOX approximately 1 cm apart along each ‘necklace’ line with some massage. Raising a wheal as in a deep dermal injection is preferable as this is an area that does tend to bruise easily. The commonest is to grasp the band and to inject approximately 15 U divided into three injection sites along each band. Alternatively, a 1.5 inch 27 gauge EMG needle can be used and passed across the width of the muscle, listening to the EMG signal to ensure that the needle remains in the muscle.
The shoulder and pectoral girdle
Ashley W. Blom, David Warwick, Michael R. Whitehouse in Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Abduction and flexion of the shoulder look simple; in fact, they are very complex movements involving all the joints of the shoulder girdle. Some weeks after an injury to the shoulder girdle a patient sometimes develops a feeling of instability in the shoulder, as if it 'slips out of joint', particularly when carrying something heavy with that arm. Pectoralis major is tested by having the patient thrust both hands firmly into the waist. The anatomy of the shoulder is uniquely adapted to allow freedom of movement and maximum reach for hand. Five 'articulations' are involved: the glenohumeral joint, the pseudojoint between humerus and coracoacromial arch, the sternoclavicular joint, the acromioclavicular joint, and the scapulothoracic articulation. Computed tomography (CT) or magnetic resonance imaging (MRI) scans are particularly helpful for surgical planning, especially for shoulder replacement or fracture surgery. Surgery is indicated for patients with severe disabling symptoms which have persisted for more than 6 months and are resistant to conservative treatment.
Upper body press exercises
Bram Swinnen in Strength Training for Soccer, 2016
The upper body pressing exercises include horizontal and vertical pressing. The horizontal pressing exercises strengthen the pectoralis major, triceps brachii, and anterior deltoid muscles. The vertical pressing exercises develop shoulder strength. Additionally the core and legs are engaged to stabilize the body when lifting overhead ( Saeterbakken and Fimland 2012 ).
Everything pectoralis major: from repair to transfer
Published in The Physician and Sportsmedicine, 2020
Kamali Thompson, Young Kwon, Evan Flatow, Laith Jazrawi, Eric Strauss, Michael Alaia
Background: Pectoralis major ruptures are increasing in incidence primarily due to an increase in awareness, activity level among young males between 20 and 40 years of age, and use of anabolic steroids. Although the majority of pectoralis major ruptures are acute injuries, many chronic ruptures are unrecognized and it is imperative to understand the proper evaluation of these injuries, as well as the appropriate treatment for acute and chronic ruptures. Purpose: Pectoralis major ruptures can lead to deformity and physical disability if left untreated. This review paper discusses both acute and chronic ruptures as well as indications for nonoperative treatment and operative treatment to give the reader the best understanding of this diagnosis and proper management. Methods: A systematic review of the literature was performed using a search of electronic databases. Search terms such as pectoralis major rupture, pectoralis major repair, pectoralis major tendon transfer, and pectoralis major nonoperative treatment were used. Case reports, systematic reviews, prospective and retrospective studies were included to provide a comprehensive review. The only exclusion criteria consisted of studies not published in English. This review article includes the anatomy and biomechanics of the pectoralis major muscle, proper evaluation of the patient, operative and nonoperative treatment of acute and chronic pectoralis major ruptures, and outcomes of the recommended treatment. Conclusion: Nonoperative treatment is indicated for patients with medical comorbidities, older age, incomplete tears, or irreparable damage. Patients treated non-operatively have been shown to lose strength, but regain full range of motion. Patients with surgery before 6 weeks reported better outcomes than patients with surgery between 6 and 8 weeks. The chronicity of the rupture (>8 weeks) increases the likelihood of reconstruction, involving the use of autografts or allografts. Patients treated with delayed repair had significantly better strength, satisfaction, and outcomes than patients with nonoperative treatment. The pectoralis tendon can also be transferred in patients with rotators cuff tears, atrophy, or significant functional limitation. Tendon transfers have been shown to have unpredictable outcomes, but overall satisfactory results.
Free flap combined with pectoralis major flap for reconstruction after total laryngopharyngectomy in patients with advanced hypopharyngeal carcinoma
Published in Acta Oto-Laryngologica, 2016
Caiyun Zhang, Minhui Zhu, Mengjie Chen, Donghui Chen, Shicai Chen, Hongliang Zheng
Conclusion: The findings suggest that a pectoralis major flap combined with a free flap is a safe and reliable method of reconstruction after total pharyngolaryngectomy; with this technique, one can help these patients remain disease free, with normal swallowing function, for a relatively acceptable survival duration. Objectives: To determine the functional and oncological outcomes of a combined flap for the extensive defects after total pharyngolaryngectomy in patients with advanced squamous cell carcinoma of the hypopharynx (SCCHP). Method: This study determined the perioperative morbidity and functional and oncologic outcomes of 21 patients with advanced SCCHP who underwent total laryngopharyngectomy and reconstruction using a combination of a pectoralis major flap and a free flap. Results: The free flap and pectoralis major flap were used to reconstruct the defects for all 21 patients. Fourteen patients were reconstructed with jejunal free flaps and pectoralis major flaps; in the remaining seven patients, anterolateral thigh flaps and pectoralis major flaps were used. All the combined flaps worked well, and patients recovered normal swallowing function a mean 19.4 days after surgery. After an overall mean follow-up time of 31.3 months, 30% of patients were still alive at the time of this analysis, with no evidence of disease.
Rupture of the Pectoralis Major Muscle
Published in The Physician and Sportsmedicine, 1997
Geoffrey P. Griffiths, F. Harlan Selesnick
Correct diagnosis of complete or partial ruptures of the pectoralis major muscle complex is important because of the muscle's vital role in shoulder function. Three case reports are used here to support a discussion of diagnosis and treatment. The diagnosis can usually be made with a history and physical exam, but magnetic resonance imaging can help pinpoint the site of a tear. Nonoperatlve treatment is generally preferred for partial tears; operative treatment may be necessary to restore full function in complete tears. Rehabilitation involves a gradual progression from pendulum exercises to range-of-motion exercises to strengthening, and patients can usually return to full activity in 3 to 6 months.