Clinical Practice and Cases in Emergency Medicine

Introduction: Pectoralis major muscle injuries are relatively uncommon and occur secondary to weightlifting in nearly 50% of cases. Tendon tears occur almost exclusively in males between 20-40 years old and are heavily associated with anabolic androgenic steroid use. While magnetic resonance imaging is often considered the modality of choice, its availability is often limited in the emergency department (ED). In contrast, point-of-care ultrasound (POCUS) is commonly available in the ED and can be used to help confirm the diagnosis and hasten disposition.

Case Report: We report a case of a 28-year-old male competitive weightlifter with a history of chronic anabolic steroid use who presented to the ED with acute left shoulder pain after weightlifting. History and physical exam were concerning for pectoralis major rupture, and POCUS confirmed the diagnosis.

Conclusion: Prompt evaluation and radiographic confirmation is key in ensuring good patient outcomes in pectoralis major tears. Therefore, proficiency of emergency physicians in musculoskeletal POCUS as an adjunct to estimate the extent of injury is important for expediting disposition and and promptly involving orthopedic surgery evaluation.