Tragedy for Gasnier

It appears that the season is over before it has begun for St George five eight Mark Gasnier. Mark pulled up sore after a seemingly innocuous tackle against the Rabbitohs in the Charity Shield match on Saturday night. Gasnier came straight off and it appears he has ruptured his Pectoralis Major Tendon

This condition was first described by Patissier in 1822, followed by Letenneur in 1861. To date, only about 150 cases have been reported in the English language, with the bulk being in the last 25 years.

Rupture of this muscle is an uncommon sports injury that has become considerably more prevalent in the last 30 years as the numbers of both professional and recreational athletes increase. Common activities associated with this injury include weight lifting (especially bench pressing), wrestling, American football, and rugby football.

Injury to the pectoralis major muscle is usually caused by a sudden forceful overload of the maximally contracted muscle. This is different from the attritional ruptures associated with the rotator cuff or biceps tendon. The patient usually gives a history suggesting a powerful contraction of the muscle or a direct blow applied to the shoulder region, with his/her arm in the adducted position.

Patients with pectoralis major tendon ruptures classically present with a history of sudden severe pain in the arm and shoulder at the time of injury, with or without a "snap", painful limitation of motion, localised swelling and ecchymosis, and weakness.

Physical examination shows a thin anterior axillary fold or even a sulcus at the deltopectoral groove. Tensioning of the pectoralis muscle creates bulging at its origins on the chest. Muscle testing shows weakness in adduction and internal rotation of the arm. Because of the rarity of this condition, the symptoms and signs may be missed on initial presentation. Sequential clinical examination is helpful in this regard.

Unfortunately these injuries do not do well with conservative treatment and not operating on this tendon can lead to permanent weakness and pain. Gasnier will probably have an urgent MRI on Monday morning and be under the surgeon’s knife later in the week in a slim bid to be ready for the semi finals.

All the best Mark