The bench presser’s shoulder

The bench presser’s shoulder

a.k.a Insertional Tendinopathy of the Pectoralis Minor Muscle

 
We commonly hear about a number of sports injuries that involve the term tendinitis. However, as practitioners we often forget a form of injury which presents very similar to tendinopathies. Enthesopathies or insertional tendinopathies indicate pathology of the small part of tissue which conjoins the bone and the tendon. This type of injury usually takes much longer to heal due to the lack of blood supply.

           

            Commonly enthesopathies will occur in athletes due to overuse. I have heard of insertional tendinopathies in the hamstrings and the Achilles tendon but never in the Pectoralis Minor muscle. To my knowledge this is the only study of its kind on the topic. 

Pectoralis Minor

            Overuse of the Pectoralis Minor muscle is common in sporting and training activities. Swimming, pushups and bench pressing can all heavily incorporate the Pectoralis Minor muscle. Injury can occur due to training errors, poor technique, rapid increase in training load, frequency or duration.

            This study looked at seven subjects who reported an increase in their bench press and sporting activity. The duration of the subject’s pain ranged from 1.5 weeks to 9 months. 

Examination

There are only a few key examination findings for a practitioner to diagnose “Bench Presser’s Shoulder”.

            1) Tenderness when palpating the Pectoralis Minor muscle. Palpation must be performed medial to the coracoids process along the inferior–medial orientation of the muscle fibers. This was positive in all seven subjects.

            2) Muscle testing of the Pectoralis Minor muscle will be aggravating. Subjects were tested while lying supine. The examiner then applies a downward force towards the table over the anterior aspect of the shoulder. The patient attempts to thrust the shoulder forward against the pressure applied by the examiner (positive 5/7).

            3) A provocative test was performed simulating a bench press maneuver. The patient is lying supine with both shoulders abducted and elbows flexed to 90 degrees. The patient then exerts an upward force against resistance (positive 6/7).

Treatment

            The only treatment performed was corticosteroid injections into the pectoralis minor insertional tendon, relative rest of aggravating activity with gradual return to play. Pectoralis minor stretching was also prescribed with no frequency given. All subjects were back to preinjury activity level within 12 weeks. Images and references of stretches given are provided. Dr. Wayne Button BSc DC

Bhatia DN, de Beer JF, van Rooyen KS, Lam F, & du Toit DF (2007). The "bench-presser's shoulder": an overuse insertional tendinopathy of the pectoralis minor muscle. British journal of sports medicine, 41 (8) PMID: 17138640
Borstad, J., & Ludewig, P. (2006). Comparison of three stretches for the pectoralis minor muscle Journal of Shoulder and Elbow Surgery, 15 (3), 324-330 DOI: 10.1016/j.jse.2005.08.011