Description
The presentation begins with Lennard Funk addressing the audience warmly and thanking BOSTAA for the opportunity to speak. He proudly represents Wrightington Hospital, where he works alongside a dedicated team of upland surgeons and therapists, influenced by the legacy of past surgical pioneers. The focus of his talk is on pectoralis major injuries, sharing his extensive experience and providing practical tips.
Funk discusses his growing caseload of pectoralis major injuries, attributing the increase to changes in patient demographics and the rise of contact sports. He emphasizes that not all injuries require surgery; about half of the patients he sees end up undergoing surgical intervention. Rugby players constitute the majority of his patients, followed by participants in martial arts.
The anatomical details of the pectoralis major muscle are explored, with Funk highlighting components not commonly referenced in textbooks, such as the clavicular and sternal contributions, and their attachment to the humerus. He presents diagnostic indicators for pec major tears, including bruising in the upper arm, muscle deficiency, and specific signs like the "dropped nipple" phenomenon.
Diagnostic imaging techniques such as ultrasound and MRI are discussed, with Funk detailing specific protocols for optimal imaging of pectoralis major injuries. He notes the challenges and nuances of diagnosing these injuries based on common presenting symptoms.
Surgical considerations are also outlined, including the decision-making process around non-operative versus surgical management. Funk underscores that while surgery can significantly restore function, it is not always necessary for every patient, especially those with less physically demanding occupations.
Specific surgical techniques are introduced, including his preferred methods for tendon repair and the importance of utilizing appropriate anchors for surgical success. Funk also addresses the challenge of chronic cases where repair isn't feasible, presenting alternatives like using allografts.
The importance of post-operative rehabilitation is underscored, with Funk advocating for tailored rehabilitation programs, particularly for athletes. He shares outcomes from published studies comparing surgical repairs with non-operative management, emphasizing that early repairs generally yield better results.
In closing, Funk acknowledges the complexity of these injuries, the potential for complications, and the importance of a collaborative approach between surgeons, physiotherapists, and patients for optimal recovery.