Pectoralis Major Muscles: Revealing the Layers of Pain

Over the past two decades, injuries to the pectoralis major muscle have become more common. This rise in prevalence is associated with the growing participation in weightlifting activities, both for recreation and in sports contexts. Oftentimes, such injuries ensue at the tendinous insertions (65%) and the musculotendinous junction (27%) [1]. The typical patient is a muscular male aged 20 to 40 years who often reports a tearing sensation, accompanied by an audible pop during weightlifting [2]. Symptoms manifest as localized pain, swelling, weakness, and ecchymosis in the axillary region and the upper arm. This injury is commonly associated with the eccentrically loaded pectoralis major during the descending phase of a bench press exercise. Clinical strength testing reveals weakness in adduction and internal rotation of the affected arm. Magnetic resonance imaging of the chest—in addition to radiographs initially used to detect acute fractures, dislocations, or bony avulsions—is generally used for the diagnosis. Herewith, ultrasound, being a readily available and cost-effective imaging modality, serves as a valuable tool for screening muscle tears [3]. In this chapter, we aim to investigate into the sonoanatomy of the pectoralis major muscle with its associated nerves and present the use of ultrasound-guided injections for managing relevant painful conditions.