Injuries to the Pectoralis Major Muscle

Abstract

Injuries to the pectoralis major muscle are relatively infrequent but result in pain, weakness, and deformity of the upper extremity. The usual injury mechanism is during eccentric shortening of the pectoralis major under heavy load, such as when performing a bench press exercise. The ability to detect and treat a pectoralis major rupture is important for both the clinician and the patient and is aided with knowledge of the anatomy, the clinical findings, and results of nonoperative and operative care. It is important to understand the physical demands and desires of the patient as well as to understand the outcomes of both nonoperative and operative care to make an informed decision regarding optimal treatment. This article highlights the importance of the clinical examination in identifying the injury, examines various surgical techniques to repair the rupture, and reports on potential complication and reinjury rates.

Pectoralis Major Repair With Unicortical Button Fixation And Suture Tape

“…Typically, the injury mechanism leading to a pectoralis major rupture involves contraction of the muscle with simultaneous external rotation and extension. 7 Although the majority of reported ruptures are seen in young males, pectoralis major ruptures have also been described in women. 8 The most common injury mechanism for these ruptures is indirect, resulting from bench press or participation in a contact sport.…”

“…8 The most common injury mechanism for these ruptures is indirect, resulting from bench press or participation in a contact sport. 7,9 During physical examination, the patient may have tenderness to palpation at the humeral insertion in conjunction with ecchymosis, swelling, and loss of the axillary fold that is normally visible with the arm in slight abduction. 7 Although mild strains or partial tears can be successfully treated with conservative management, surgical treatment is indicated for total ruptures to avoid loss of strength during adduction, forward flexion, and internal rotation of the extremity.…”

“…7,9 During physical examination, the patient may have tenderness to palpation at the humeral insertion in conjunction with ecchymosis, swelling, and loss of the axillary fold that is normally visible with the arm in slight abduction. 7 Although mild strains or partial tears can be successfully treated with conservative management, surgical treatment is indicated for total ruptures to avoid loss of strength during adduction, forward flexion, and internal rotation of the extremity. 1 As a result of low functional demands, however, elderly and less active patients with a pectoralis major rupture may be conservatively treated.…”

Pectoralis Major Repair With Cortical Button Technique

“…1,2 These injuries occur through an indirect mechanism such as forced abduction against resistance, high forces of traction on the arm, and involuntary contraction of the muscle. [3][4][5][6] In weightlifters, particularly when bench pressing, the injury occurs during the eccentric phase of contraction as tension increases.…”

“…3 Because the pectoralis major is a powerful adductor and internal rotator of the arm, 1,9 rupture of the tendon can lead to significant functional deficits and impede highlevel athletic or labor-intensive activities. In addition, rupture of the pectoralis major tendon leads to cosmetic deficits in the anterior axillary fold.…”