Pectoralis Major Rupture

Description

Pectoralis major rupture is a partial or complete tear of the pectoralis major tendon. This structure is the tendon attachment of the pectoralis major muscle to the arm bone (humerus). The pectoralis major muscle becomes a tendon at the outer chest, and the tendon attaches to the humerus. With pectoralis major rupture, a loss of continuity occurs between the pectoralis major muscle and the humerus, and thus function of this muscle is lost. The function of the pectoralis major is to forcefully bring the arm to the midline or across the body and to rotate the arm inward. Rupture of the pectoralis major usually involves the tendon pulling off the humerus, although occasionally the tear may occur in the mid belly of the muscle, the thickest part, or at the junction, where the muscle becomes tendon.

Common signs and symptoms

• A pop, rip, or tearing and severe sharp, often burning pain in the chest at the time of injury

• Tenderness, swelling, warmth, or redness and later bruising over and around the pectoralis muscle–tendon, chest, and armpit region

• Pain and weakness when trying to forcefully bring the arm across the body or rotate the arm inward

• Loss of contour of the armpit region, especially when pushing your hands together in front of your body

• Loss of firm fullness when pushing on the area where the tendon ruptured (a defect between the ends of the tendon and bone, where they separated from each other)

Causes

• A sudden episode of stressful overactivity

• A direct blow or injury to the chest

• Falling from a height

Factors that increase risk

• Sports that require excessive muscle stress, such as with bench press weight lifting

• Contact sports with minimal protection for the chest

• Wrestling

• Poor physical conditioning (strength, flexibility)

• Previous pectoralis major tendon injury

• Untreated pectoralis major tendinitis

• Cortisone injection into the pectoralis major tendon

• Oral anabolic steroid use

Preventive measures

• Appropriately warm up and stretch before practice and competition.

• Allow time for adequate rest and recovery between practices and competition.

• Maintain appropriate conditioning that includes cardiovascular fitness, shoulder flexibility, and strength and endurance training.

Expected outcome

Rupture of the pectoralis major is usually curable with appropriate treatment. Sports can usually be resumed after 6 to 9 months.

Possible complications

• Weakness of the pectoralis major, especially if untreated

• Re-rupture of the tendon after treatment

• Prolonged disability

• Risks of surgery, including infection, injury to nerves (numbness, weakness, or paralysis), bleeding, hematoma, pseudocyst, shoulder stiffness, shoulder weakness, and pain with strenuous activity

• Loss of chest or armpit contour

• Inability to repair the rupture

General treatment considerations

Initial treatment consists of rest and icing of the area, and a sling may be provided for comfort. Small or partial pectoralis major tendon injuries may be treated with heat, ultrasound, and shoulder motion exercises. These may be done with the assistance of a physical therapist or athletic trainer. Strengthening may be started after a few weeks, although treatment of complete tears is somewhat controversial. Tears in the mid belly of the pectoralis major muscle and at the muscle–tendon junction are not amenable to repair. For the active athlete, surgical reattachment of the tendon to the humerus is often advocated. Without surgery, the loss of normal armpit contour and weakness of the shoulder will persist. Repair within the first few weeks provides a better result and is technically easier to perform. After surgery and immobilization, physical therapy is usually needed to regain shoulder motion and strength.

Medication

• Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take for 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician, and contact your doctor immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Stronger pain relievers may be prescribed for you. Use these only as directed, and take only as much as you need.

Cold therapy

Cold is used to relieve pain and reduce inflammation. It should be applied for 10 to 15 minutes every 2 to 3 hours as needed and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

When to call your doctor

• Pain increases despite treatment.

• Any of the following occur after surgery: signs of infection, including fever, increased pain, swelling, redness, drainage, or bleeding in the surgical area.

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