This case report describes a patient referred to a physical therapist for treatment of a shoulder strain who was eventually diagnosed with a rupture of his pectoralis major tendon that required surgical repair. The purpose of this case report is to highlight the management of this injury within the unique constraints of a combat environment.
A 29 year-old man, currently serving as an active duty Soldier in the U.S. Army in Iraq had a sudden onset of right shoulder pain during the concentric portion of a bench press. He was seen by a physician immediately following the injury, diagnosed with a shoulder strain, and referred to a physical therapist for a sling and exercise instruction. Based on the history and physical examination findings, which were consistent with a pectoralis major tendon rupture, the physical therapist placed a consult to an orthopaedic surgeon in the United States through teleconsultation since orthopaedic surgeons were not easily accessible in Iraq for non-emergent musculoskeletal referrals. Subsequently, the orthopaedic surgeon advised evacuating the patient out of Iraq for surgical management.
The patient was diagnosed via magnetic resonance imaging with a rupture of his pectoralis major at the musculotendinous junction near its insertion into the greater tubercle of the humerus that required surgical repair. At 3 months following surgery, the patient had full pain-free shoulder active range of motion and had progressed well through his strengthening program in a manner that allowed return to full duty. At 6 months following surgery, the patient maintained his full duty status and was performing a routine of strength training 3 times per week, and had met all of his rehabilitation and personal goals.
Successful management of this patient depended upon analysis of the history and physical examination findings by the physical therapist to form an accurate diagnosis. In addition, timely medical evacuation and referral to an orthopedic surgeon for surgical management were coordinated in a combat environment. Completion of a progressive rehabilitation program following pectoralis major tendon repair also contributed to this patient’s full recovery and return to duty. Had the physical therapist only followed the initial referral request, given this patient’s military duties and sports and recreational activities, this case would likely have resulted in suboptimal outcomes.
Source: http://ptjournal.apta.org/cgi/content/short/ptj.20120141v1?rss=1
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