Pectoralis Major Tendon Rupture

Ruptures of the pectoralis major muscle are uncommon. They generally follow extreme muscle contractions and are associated with weight lifting (bench press), and attempting to break a fall with an outstretched arm. Pectoralis major ruptures most commonly occur in men, age 20-40, and are rare in women. Patients often report a pop or tearing sensation in shoulder when doing an activity requiring maximal eccentric muscular contraction with arm in abducted extended position such as during dips and bench press. Pain, limited motion, swelling, bruising and weakness in the anterior shoulder and chest generally follows pectoralis ruptures.

When untreated people generally report cramping pain and weakness in the shoulder and chest with activities which stress the pec major (dips, bench). They may also notice an asymmetric bulge in the muscle. People generally do not have rest pain or loss of motion. Pec major function is not necessary for normal shoulder function. Activities involving arm flexion, adduction, and internal rotation may be limited especially with strenuous activity. Non-operative treatment may lead to adduction and internal rotation weakness and a significant cosmetic defect. Isokinetic adduction strength testing has shown that without surgical repair patients will have approximately 71% the strength of the uninjured arm. With acute repair patients generally regain full strength. With delayed repair patients have been shown to regain 94% of their strength.

Surgical treatment for complete pectoralis major ruptures and the expected outcomes of surgery are dependent on the location of the tear and the delay in surgery. If you are considering surgery for a torn pectoralis major tendon you should discuss the type of tear you have and the expected outcomes with your surgeon. Studies have shown that overall 88% of patients undergoing repair have excellent to good results while only 27% of patients treated without surgery have excellent to good results.

The potential complications of surgery include but are not limited to: Persistent weakness, Myositis Ossificans, Shoulder stiffness, Re-rupture / failure, incomplete relief of pain, incomplete return of function or motion, incomplete return to sport, need for further surgery, infections, ectopic calcification, reactive bursitis, CRPS, nerve or vascular injury, hematoma, DVT/PE, and the risk of anesthesia including heart attack, stroke and death. Complications are uncommon and the most patients are satisfied with the results of surgery.

Following surgery people generally are placed into a shoulder immobilizer for 4-6 weeks. Patients begin Elbow/wrist/hand range of motion exercises immediately. They follow-up with there surgeon 10-14 days after surgery. At 6 weeks patients begin gentle passive ROM exercises and gradually advance to full ROM and gentle periscapular strengthening exercises. At 3 months, ROM should be nearly full and pectoralis major muscle strengthening is begun. At 6 months, push-ups and dumbbell bench presses with light weight and high repetition are started. At 9 to 12 months patients generally return to full-activities. Patients should avoid high-weight, low repetition barbell bench pressing indefinitely.

Every person and their particular circumstances are different so the treatment for your shoulder may be different than those discussed. Please read this information carefully. Write down any questions that you have about your shoulder and its treatment and discuss them with your orthopaedic surgeon. Working together you and your orthopaedic surgeon will determine the best treatment for you.

Synonyms: 
pec major tear, pec major rupture, pectoralis tendon rupture

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