Latissimus and Pectoralis Tendon Injuries in the Overhead Athlete: Evaluation and Management

Latissimus dorsi (LD) and pectoralis major (PM) tendon injuries are uncommon injuries in overhead athletes. The unique anatomical and biomechanical characteristics predispose the LD and PM to injuries during overhead activity. Although each overhead sport has different mechanics and phases of overhead activity, many similarities affecting the LD and PM are seen in each sport. Although a thorough history of the athlete's symptoms and overhead activity is paramount, a keen understanding of each sport's overhead mechanics may help with establishing the right diagnosis. A physical examination is important to identify these injuries given their low incidence and need for appropriate imaging during the clinical workup. Standard shoulder magnetic resonance imaging techniques may not be sufficiently caudal to demonstrate LD or PM pathology. Operative management is usually recommended for LD and PM tendon tears in other athletes. However, overhead athletes represent a unique population who commonly sustain only partial tears where nonoperative management has demonstrated excellent results. However, in throwing athletes with complete tears and extensive retraction, LD and PM tears may require surgical repair. Rehabilitation should progress with caution to minimize reinjury, which is common in athletes returning too quickly. Although overuse is the most likely reason for LD and PM injuries in overhead athletes, proper mechanics are essential to help reduce the chance of injury.