ABSTRACT
The large size and central location of the chest lead to frequent injury; however, the anatomic architecture of the thorax, particularly its bony support and muscular development, provides adequate protection against all but the most serious trauma. Contusions and strains, therefore, while common in collision and contact sports (e.g., cricket, football, rugby, hockey), are usually mild in nature and respond well to standard therapy. More significant injuries (e.g., breast contusions, third-degree strains) may be associated with a hematoma and should be surgically aspirated. Subcutaneous fat necrosis has been reported following breast hematomas. Third-degree strains of the pectoralis major muscle are associated with a “pop” or “snap” sound; sudden, sharp, upper-arm pain; ecchymosis; muscle belly bulging on resisted adduction; weakness of arm adduction, flexion, and internal rotation; a gap in the anterior axillary fold; and an absent pectoralis major shadow on a chest film. Surgical repair is recommended for young or professional athletes in order to restore full function and strength. Total recovery time is often 3 to 6 months.
