Pectoralis minor syndrome

Pectoralis minor syndrome is a condition in which the pectoralis minor muscle, which is inserted between the scapula and the 3rd to 5th ribs, compresses nervous or vascular structures such as the brachial plexus, axillary artery, or axillary vein. Its stiffness, shortening, inflammation, or the presence of trigger points (contractures that occur within the muscle. See the article on myofascial pain) can cause alterations in scapular mobility (scapular dyskinesis) and compression of these neurovascular structures.

It is a syndrome that is part of another syndrome, which we have already discussed.(https://drjordijimenez.com/en/dr-jordi-jimenez/blog-take-care-of-your-health/thoracic-outlet-syndrome)

In which compression of the brachial plexus occurs below the clavicle, specifically below the muscle's insertion on the coracoid process (scapula).

Causes of Pectoralis Minor Syndrome
The etiology of pectoralis minor syndrome is multifactorial and may include a combination of anatomical, postural, and overuse factors. Some of the factors that may contribute to its development include:

• Abnormal anatomy: Some people have anatomical variations in the muscle insertion that make them more prone to developing pectoralis minor syndrome.
• Incorrect posture: Maintaining incorrect posture for a prolonged period or pre-established poor posture, with the shoulders excessively anterior, can increase tension in the pectoralis minor and contribute to compression.
• Throwing sports that involve overhead arm activity, such as baseball, basketball, tennis, volleyball, handball, or swimming, can increase the risk of developing pectoralis minor syndrome.
• Strenuous physical activity: Weightlifting, swimming, and other strenuous sports can increase tension in the pectoralis minor muscle and contribute to its development.
• Repetitive trauma: These lead to the formation of tension and trigger points in the pectoralis minor muscle, which cause it to shorten and can increase the risk of developing pectoralis minor syndrome.
• Acute trauma: Neck hyperextension injuries, car accidents, and whiplash can cause pectoralis minor syndrome.

Pain is usually the main symptom, located in the anterior shoulder, chest, neck, and arms, where numbness, numbness, and tingling can reach the fourth and fifth fingers. If there is compression of vascular structures, patients may report coldness in the affected arm or edema and swelling of the arm.

Diagnosis of Pectoralis Minor Syndrome
The diagnosis of pectoralis minor syndrome is made through a combination of clinical history, physical examination, and imaging tests. Its diagnosis is often delayed and challenging for the specialist, given that the symptoms are common to other conditions such as nerve entrapment in the arm or neck problems. Some of the steps that can be taken to diagnose pectoralis minor syndrome include:

• Clinical history: The doctor will ask about the patient's symptoms, medical history, and lifestyle, including occupation, sports, and history of previous trauma.
• Physical examination: The doctor will perform a physical exam to assess strength, mobility, and sensation in the shoulder and arm. Diagnostic tests are available to reproduce the patient's painful symptoms.
• Imaging tests: Imaging tests, such as X-rays, MRI, or CT scans, can help confirm the diagnosis and rule out other causes of shoulder pain, although they are usually normal. Electromyogram: This may reveal abnormalities due to compression of the brachial plexus. It is generally normal or may show parallel nerve compression in the arm or neck that coexists with pectoralis minor syndrome.
• Electromyogram: This may reveal abnormalities due to compression of the brachial plexus. It is usually normal or may show parallel nerve compression in the arm or neck that coexists with pectoralis minor syndrome.

Treatment for Pectoralis Minor Syndrome
Treatment for pectoralis minor syndrome depends on the severity of symptoms and the underlying cause. Some of the most common treatments include:

• Physical Therapy: Physical therapy can help strengthen the shoulder muscles and correct posture. The therapist may also provide specific exercises to relieve tension in the pectoralis minor and improve mobility. Pectoralis minor stretches and postural correction are the cornerstone of rehabilitation treatment.
• Manual Therapy: Manual therapy, such as soft tissue manipulation, can help reduce inflammation and pain in the shoulder.
• Regulation and Modification of Activities of Daily Living: Modifying or avoiding certain activities that may be contributing to pectoralis minor syndrome can help relieve symptoms.
• Ultrasound-Guided Injections: Ultrasound-guided injections that combine anesthetics and corticosteroids can provide diagnostic guidance while simultaneously treating pectoralis minor pain.

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In severe cases, a combination of treatments may be necessary to achieve significant improvement in symptoms. It is important to consult with an orthopedic surgeon to determine the appropriate treatment for each individual case.