Pectoralis major injury

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What is pectoralis major rupture?

The pectoralis muscle is located at the front of your chest. It comprises:

  • The pectoralis major – the larger of the two muscles which helps to move the arms in front of the body
  • The pectoralis minor – a thin, flat muscle immediately underneath the pectoralis major which lifts the rib cage and moves the shoulder blade forwards

Both the pectoralis major muscle and its tendon (which attaches to the upper arm bone) can become torn. This is a fairly uncommon injury that mostly affects men aged between 20 and 50, particularly those who use steroids as they strengthen the muscle disproportionately to the tendon.

Pec major repair by Mr Ali Noorani for Professional Footballer Barry

What causes a pectoralis major rupture?

A pectoralis major rupture includes either a partial or total tear of the muscle or tendon. It is usually caused by activities that involve a large amount of force, such as bench press exercises during weightlifting. It can also occur in other high impact sports such as wrestling, rugby or American football, as well as severe trauma and accidents.
Damage may occur where the tendon of the pectoralis major joins the upper arm bone or where the muscle joins the tendon. The muscle itself may also rupture or may on rare occasions tear off the sternum.

What are the symptoms of a pectoralis major rupture?

When the muscle ruptures you will experience a tearing sensation in the chest and you may hear a popping sound. This will be accompanied by a sudden severe pain and you will no longer be able to support any heavy weight. You may also have pain in the upper arms as well as weakness and bruising. You may notice a deformity of your pectoralis major, with a lump in the armpit or chest caused by bunching of the pectoralis muscle.

How is a pectoralis major rupture diagnosed?

Your consultant will carry out a physical examination and ask how the injury occurred. An MRI scan will be used to determine the location and extent of the tear, including whether it is a partial or complete tear and whether it is mainly in the tendon, or the muscle itself.

How is a pectoralis major rupture treated?

Depending on the severity and location of the rupture a number of different surgical procedures may be possible:

  • If the tendon has torn off the bone, you may be offered open surgery. A suture anchor device will be used to place sutures into the bone and reattach the tendon. You will need to wear a sling and you will be shown exercises to strengthen the muscle as it begins to heal.
  • If the tear has occurred at the junction between the muscle and the tendon, repair is more difficult as it is not possible to suture reliably into muscle. Your consultant may recommend waiting for some scar tissue to form on the pectoralis muscle and may suggest using a donor tendon.
  • If the tear has occurred wholly within the muscle, repair may or may not be possible depending on how much scar tissue forms.

It can take at least six months to recover from a repaired pectoralis major rupture and around a year before full strength returns.

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