Shoulder - Pectoralis Major Rupture

Description

The Pectoralis major is a very powerful muscle that forms the chest prominence and. It moves the shoulder forwards and across your chest. It is best known as the muscle that you develop with the bench press exercise. 

The pec major attaches to the humerus bone (upper bone of arm) and is divided into two parts. The upper part is known as the 'clavicular head' and the lower part the 'sternal head', based on their origins from the clavicle and sternal bones respectively..

What are the causes?

Ruptures of the pectoralis major muscle are becoming more common due to the increase in power sports weight training. It most commonly occurs during bench pressing and is felt as a painful snap at the front of the shoulder and chest. The muscle then 'bunches up' and deforms. 

What are the symptoms?

Rotator cuff tears cause pain, bruising and swelling is common.

How is it diagnosed?

Dr. Liu will perform a thorough history and physical exam including X-rays. Exam findings may consist of weakness and pain with muscle testing. MRI will be ordered to confirm diagnosis.

The Pectoralis major may tear/rupture in the following parts of the muscle: 

  1. Tendon rupture off the humerus bone (most common)
  2. Tear at the junction of the muscle and tendon (musculo-tendinous junction)
  3. Tear within the muscle belly itself
  4. Muscle tearing off the sternum (very rare)
Non-operative

The pec major muscle is not essential for normal daily shoulder function, but is important for strenuous activities. If the patient has low demand for physical activity, a non operative course may be considered. Rest, ice, NSAIDS and a course of physical therapy would be recommended.

Operative

Patients who wish to return to active athletic and manual activities are likely to benefit from surgical repair. Patients who have surgical repair have less pain, a higher rate of pre-injury strength and return to activities, than patients managed non operatively. The earlier a repair is performed the easier the surgery.

There are situations where  the tear cannot be directly repaired (i.e. massive, involving musculo-tendinous tissue or chronic) reconstruction can be considered. Achilles Tendon allograft can be used to reconstruct the pectoralis tendon. 

Repair vs Reconstruction:

Acute (less than 3 months)

  • Tendon avulsion - repair as soon as possible directly to the bone
  • Musculo-tendinous tear - may consider waiting for consolidation of the scar tissue and sew the muscle-tendon junction with a special high strength suture material that encourages healing, allograft may be beneficial
  • Muscle tear- extremely rare and difficult to repair, but can do as above and reinforce with achilles tendon allograft.

Chronic (greater than 3 months)

  • Tendon avulsion - if retracted lateral to nippple line usually can still do a direct repair; if retracted may needs an achilles allograft reconstruction

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