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Pectoralis Ruptures


Tearing away or rupture of the Pectoralis Major tendon from the humerus (upper arm bone) is a relatively uncommon injury.  These injuries typically occur in weight-lifters especially during bench press.  The most severe muscle contraction occurs during the downward motion of the bench press and it is at this moment when most pectoralis ruptures occur.  In these moments the muscle is contracting with great force while at the same time the muscle is lengthening allowing extension of the arm.  These injuries can also happen in football players, especially lineman, and in wrestlers.  Because of the infrequent nature of these injuries they can often be missed or not diagnosed, however most bench pressing injuries are obvious to the patient as they feel a tearing or popping at the moment of injury and will drop the weight bar.

The pectoralis major is a very large muscle that originates from the clavicle or collar bone at its upper end and the sternum or breast bone and even has some attachments to the upper ribs.  It travels outward toward the arm and attaches to the humerus with a large tendon.  It is responsible for the majority of force required to internally rotate the arm, bring the arm towards the body, and also is involved with elevation of the arm.    

The most common portion of the pectoralis tendon to rupture is the lower half and it is this portion that normally forms the contour of the upper axilla or arm pit.  When the rupture occurs there is swelling and bruising evident on the pectoralis and upper arm.  Patients, especially body builders will notice a lack of the normal contour of the axila and will see abnormal movement of the muscle when trying to contract their pectoralis. 

Typically xrays will not reveal any type of bone injury and MRI is required to further define the injury.  MRI is important to distinguish a ruptured tendon from an injury further over into the muscle itself as the treatment for these will vary.  The most common form of the injury is tearing away of the tendon directly off the bone.  The MRI will also help to distinguish partial from complete injuries, which will help determine treatment options.

When there is a complete tearing of the tendon away from bone treatment usually consists of surgical repair of the torn tendon.  However some patients may not require or desire surgery.  In the case of a purely muscular tear without a ruptured tendon time and therapy will usually suffice for healing.  In the case of a tendon tear in an elderly patient with low physical demands repair may not be required although some strength will be lost.  The vast majority of these injuries are in young and active people and repair is recommended to restore strength and function.

Successful repair is obtained in nearly 90% of cases with return of strength and mobility.  The optimum time frame for repair is within 1-2 weeks from injury.  Older injuries can be repaired, but success rate will depend on length of time from injury to surgery and quality of the tendon. 

The procedure for repair involves an incision near the axillary fold in the front of the arm/shoulder.  Strong sutures are placed in a locking fashion into the ruptured end of the tendon.  Various methods are then used to re-attach the pectoralis tendon to the bone.  Effective methods include tunnels in the bone, suture anchors, and suture buttons.  All of the methods can provide secure repair to the bone and allow for the body the heal the tendon back into place.  This is an out-patient procedure done under general anesthesia.  Patients will use a sling for about 1 month after surgery and will begin a physical therapy protocol usually within the first week.  Over the course of 6 weeks the patient will regain full range of motion and strength training will begin at that time.  Typically return to full strength and activity is in the 4-6 months range.  However bench pressing is usually discouraged for 6-9 months.  

Overall surgical repair is a highly successful procedure for this somewhat rare injury.  It is of great importance to be evaluated by an orthopedic surgeon if you suspect a pectoralis injury has occurred. Things to look for are severe pain/tearing during bench press or other sport, bruising along the pec muscle, or deformity of the pec muscle or abnormal appearance of the upper fold of the arm pit.  If these are present there is a high likelihood of pectoralis rupture.