Identifying and treating pectoralis minor syndrome in women with breast hypertrophy, poor posture and diffuse shoulder symptoms.

Pectoralis minor syndrome (PMS) has been identified as a cause of chronic shoulder pain, involving compression of the brachial plexus at the thoracic outlet associated with scapulothoracic abnormal motion (STAM). This condition is poorly recognised and frequently overlooked in clinical practice.We present three patients with breast hypertrophy who experienced shoulder girdle pain and intermittent paraesthesia. Ultrasound-guided pectoralis minor (PM) muscle blocks provided effective but transient relief. Definitive treatment with arthroscopic PM release (APMR) resulted in durable symptom resolution.PMS is often overlooked due to its diffuse symptoms. Although women have been reported to suffer from PMS more frequently, this is the first report to describe the association between female gender, breast hypertrophy, postural overload and PMS, as well as the outcomes in these patients after APMR. Based on the current literature and our clinical experience, we propose an assessment and treatment algorithm for this challenging syndrome.