Pectoralis Major Rupture
The pectoralis major muscle is a large powerful muscle at the front of the chest wall. It has a sternocostal head arising from sternum and costal cartilages and a clavicular head arising from the anterior clavicle, both converging onto the upper humerus. It is a very powerful adductor, internal rotator and flexor of the shoulder.How does a pectoralis major muscle rupture occur?
A traumatic rupture occurs due to excessive tension on a maximally eccentrically contracted muscle. This is most common in weight lifters, particularly during a bench press manoeuvre. It is also seen in wrestling and rugby. Athletes who take steroids are at particular high risk of developing this injury as the steroid can weaken the tendon.What are the clinical features of a pectoralis major muscle rupture?
- Sudden sharp pain, and often a tearing sensation in their chest.
- Extensive bruising in the chest and arm
- A palpable defect just above the arm pit
- Localised swelling where the rupture occurred
- Weakness in adduction and internal rotation
Treatment of a Pectoralis Muscle Rupture
Surgery is almost always recommended for complete tears of the pectoralis muscle tendon. This is particularly the case for athletic individuals who wish to return to high-level sports and activities.
The results of surgery are best when surgery is performed as soon as possible. Acute surgical repair has the best chance of achieving best possible outcome and minimises tendon retraction and muscle atrophy.
Sometimes, an acute rupture is unrecognised and the diagnosis made after it has become a chronic condition. Surgical repair can still be carried out at a late stage (as long as years) although the results are likely to be inferior to acute repair.
Technique of surgical repair
The repair is performed through a small open incision along the axillary crease. The tendon is repaired directly to bone by using multiple suture anchors inserted in the bone.
The small scar is created along the axillary crease and barely visible in resting arm position
The scar is evident when the arm is lifted from the side
Although the pectoralis major muscle is often seen as not essential for normal daily shoulder function, it is however crucially important for athletic individuals who wish to regain full strength whilst performing strenuous activities. They are most likely to benefit from surgical repair.