From the Guidelines
Pectoralis major humeral insertion tendinopathy with calcification should be treated with conservative measures as the first line of treatment, including rest, ice, and eccentric strengthening exercises, with surgery reserved for cases that do not respond to 6 months of conservative treatment. The condition is characterized by inflammation and calcium deposition in the tendon connecting the pectoralis major muscle to the humerus, often due to repetitive microtrauma from weightlifting or sports requiring forceful pushing movements 1.
Treatment Approach
- Rest from aggravating activities, particularly those involving pushing or chest exercises, for 4-6 weeks
- Apply ice for 15-20 minutes several times daily to reduce inflammation
- Take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 400-600mg three times daily with food for 1-2 weeks to manage pain and inflammation
- Physical therapy focusing on gentle stretching and progressive strengthening exercises is recommended 2-3 times weekly for 6-8 weeks
- For persistent symptoms, consider a corticosteroid injection administered by an orthopedic specialist
- Ultrasound-guided needling or extracorporeal shock wave therapy may help address calcification
Surgical Intervention
Surgery is an effective treatment option in carefully selected patients, typically including excision of abnormal tendon tissue and performance of longitudinal tenotomies to release areas of scarring and fibrosis 1. However, surgery should only be considered after a well-managed conservative treatment trial has failed to alleviate symptoms.
Recovery and Prognosis
Recovery from pectoralis major humeral insertion tendinopathy with calcification typically takes 3-6 months with appropriate treatment and gradual return to activities. Most patients (about 80 percent) fully recover within three to six months with conservative treatment 1.
From the Research
Pectoralis Major Humeral Insertion Tendinopathy with Calcification
- Pectoralis major humeral insertion tendinopathy with calcification is a rare condition, with few cases reported in the literature 2, 3, 4.
- The condition can present with severe, disabling pain in the shoulder, usually in the morning and after effort, and can be diagnosed using magnetic resonance imaging (MRI) and computed tomography (CT) scans 2.
- Non-surgical management, including physiotherapy and painkillers, can be effective in treating the condition, with complete calcification resorption reported in some cases 2.
- In some cases, surgical treatment may be proposed to shorten the necessary rehabilitation time, but a biological assessment to research a systemic etiology is mandatory and standardized 2.
- The condition can be associated with hyperparathyroidism, and a biopsy is not required, with radiological examinations being sufficient for diagnosis 2.
Diagnosis and Treatment
- Ultrasound features of painful intraosseous migration of pectoralis major tendinous calcifications can be diagnostic and may help avoid additional costly imaging studies or invasive biopsy 5.
- The anatomic location of the humeral insertion of the pectoralis major tendon can be located in repair of pectoralis tendon injuries by referencing the superomedial corner of the greater tuberosity and the lateral lip of the bicipital groove 6.
- Calcification migration into osseous structures is associated with cortical erosions, intraosseous calcifications, and bone marrow edema, which can be misleading on MRI and may raise concerns regarding neoplasia 5.
Clinical Presentation
- Patients with pectoralis major humeral insertion tendinopathy with calcification can present with pain in the arm and a radiographic lesion of the upper humerus, which can warrant surgical exploration and excision biopsy 4.
- The condition can resolve spontaneously without specific treatment, and this unusual site of calcification should be kept in mind to avoid unnecessary surgical intervention 3.