Pectoralis Major Tendon Tear
The pectoral muscles, colloquially referred to as “pecs”, are located on each side of the sternum (breastbone) and reside under the breast or fatty tissue of the chest. There are two such muscles: the pectoralis major and the pectoralis minor.
The pectoralis major muscle is a thick, fan-shaped muscle that extends across the upper part of the chest. The muscle is composed of two parts: the clavicular head and the sternocostal head. The clavicular head originates at the clavicle and extends down the humerus (upper arm bone). The sternocostal head originates from your sternum, ribs, and external oblique muscle, and attaches to the humerus along with the clavicular head.
The pectoralis minor lies underneath the pectoralis major. It originates from the middle ribs and attaches to the shoulder blade. These muscles help you move your shoulder, and are responsible for internal rotation, forward elevation, and adduction of the arm (pulling your arm across the front of your body).
Injury to the pectoral muscle, such as a rupture or tear, can cause shoulder pain and limit the use of the arm.
In isotonic contraction, muscle tension remains constant and the length of the muscle changes. There are two subtypes of isotonic contractions: concentric and eccentric. Concentric contraction is when the muscle shortens, and eccentric contraction is when the muscle lengthens.
Eccentric contraction occurs when the force applied to the muscle exceeds the force that the muscle can generate. For example, the lowering of weights during a biceps curl is a movement that employs eccentric contractions.
The injury results from a violent, sudden eccentric contraction of the muscle, and commonly presents as a sports injury. Typically, the mechanism of a pectoralis major tendon tear is such an eccentric contraction.
Classification of Pectoralis Tendon Tears
A severe injury can cause the pectoralis muscle to partially or completely tear. Tears are categorized by grades according to severity (the number of muscle fibers torn and how much function is lost).
- Grade 1: Overstretching of the tendon
- Grade 2: Partial tear (the most common classification)
- Grade 3: Complete tear of the pectoralis tendon
The pectoralis major tendon is usually injured during an eccentric contraction. A pectoralis major tendon tear is a relatively rare injury, and is seen in athletes over 50% of the time—particularly in weightlifters performing bench presses. Other sports that can lead to this type of injury include: rugby
- water skiing
A pectoralis major tendon tear typically presents in male athletes aged 20 to 40. This injury can result in significant disability in athletes. While it is still uncommon, the number of cases has risen over the past 30 years, which coincides with an increase in recreational and professional athletes.
The injury can present with symptoms of weakness, pain in the upper chest and arm, and deformity of the upper chest and arm. Patients often report hearing or feeling a “pop” or tearing sensation. Other symptoms include:
- sudden and severe pain at the time of the injury (localized to the chest and front of the shoulder, but may radiate into the upper arm or neck)
- tenderness upon palpation
- limited range of motion (difficulty moving the arm inward or across the body)
- asymmetrical/abnormal contour of the chest and upper arm
- bruising of the chest
Chronic tears of pectoralis major can cause a decrease in muscle mass.
In the acute phase of the injury, swelling and pain may distort the shoulder and affect strength and motion testing. Once the swelling has subsided, diagnosis of a pectoralis major tendon tear can typically be made through a physical examination. Doctors may notice bruising, swelling, and abnormality of the chest and upper arm.
X-rays may be used to look for an associated fracture or bone fragment on the tendon, but more commonly, a magnetic resonance imaging (MRI) scan will be ordered. This imaging test can be used to confirm the diagnosis, determine the site, and classify the injury by grade. Since ultrasound images are low cost and readily available, they may be useful in identifying tears, although MRI is considered the most appropriate imaging modality.
The grade and location of the tear, as well as the patient’s age, activity level and desired outcome will play a role in choosing the best treatment. In patients who have low activity levels, nonsurgical treatment options such as rest, ice, immobilization and range of motion exercises may provide acceptable to excellent results. Typically surgery is recommended for most younger patients or laborers. For athletes who wish to return to their sport, surgical treatment may be the best option.
In cases of chronic tendon tears that are retracted, a reconstruction is often needed. Dr. Patel has performed these reconstructions and other complex repairs with success. Other surgeons often refer these complicated cases to Dr. Patel for his expertise.
The primary treatment for a pectoralis major tendon tear is an open pectoralis major tendon repair.
During an open pectoralis major tendon repair surgery, the patient is typically placed under general anesthesia. The surgeon will then make an incision in the shoulder area, usually in the armpit, to access the torn or ruptured tendon.
Once the tendon is exposed, the surgeon will carefully reattach the torn ends of the tendon using sutures or other techniques, which may involve using anchor devices to hold the tendon in place on the upper arm bone.
After the procedure, the patient will typically require a period of immobilization to allow the tendon to heal properly. This may involve wearing a sling or other supportive device for several weeks, as well as undergoing physical therapy exercises to help restore strength and mobility to the affected area.
Open pectoralis major tendon repair surgery is generally considered a safe and effective procedure for repairing a torn or ruptured pectoralis major tendon, although as with any surgical procedure, there are risks involved, such as infection, bleeding, and damage to surrounding structures. Your doctor can provide more information on the risks and benefits of this procedure based on your individual case.
At a Glance
Ronak M. Patel M.D.
- Double Board-Certified, Fellowship-Trained Orthopaedic Surgeon
- Past Team Physician to the Cavaliers (NBA), Browns (NFL) and Guardians (MLB)
- Published over 49 publications and 10 book chapters
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