Abstract / Summary
# BACKGROUND Pectoralis major tendon rupture in high-level female wrestlers is extremely rare, and evidence regarding rehabilitation and return-to-sport criteria is limited. The purpose of this case report was to provide detailed information regarding quantitative assessment of postoperative recovery, focusing on maximal and rapid isometric force production following pectoralis major tendon repair in a world-class female wrestler.
# STUDY DESIGN Case report
# CASE DESCRIPTION A world-class female wrestler in her 20s sustained rupture of the sternocostal and abdominal heads of the right pectoralis major at the humeral attachment and underwent tendon repair six days after injury. Resistance training began at week nine and wrestling-specific drills began at week 14. She returned to competitive training at week 18 and official competition at week 24.
# OUTCOMES Shoulder strength was assessed weekly from postoperative week 6 to 16 using the Athletic Shoulder (ASH) Test with a force plate. Net peak force (NPF) and net force at 200 ms (NF200) were measured in the I-position (180°), Y-position (135°), and T-position (90°). NPF limb symmetry improved by week 11 in the I- and Y-positions, while NF200 recovery lagged behind NPF, particularly in the Y-position. A temporary decrease in NPF and NF200 was observed at week 14, most pronounced in the Y-position. Coefficient of variation for NF200 remained higher on the operated side than on the contralateral side. Training progression and return-to-sport clearance were guided by pain response, shoulder range of motion, exercise and sport-specific tolerance, ASH test findings, and physician assessment.
# DISCUSSION NF200 recovery lagged behind NPF, suggesting that rapid force production may remain impaired after peak force has recovered. Recovery patterns were angle-dependent, supporting multidirectional assessment. Strength decline after wrestling-specific training also supports continued neuromuscular monitoring.
# CONCLUSION In this athlete, repeated ASH testing appeared to assist clinical monitoring by detecting position-specific changes in maximal and rapid force production during the return-to-sport process.
# LEVEL OF EVIDENCE 5