Pectoralis Major Tendon Tear

Abstract

Pectoralis major (PM) tendon tears are predominantly seen in young men, and the majority of tears occur as tendon avulsions involving the sternal head. Weightlifting, specifically bench-pressing, and sporting activities with eccentric overloading of the PM tendon are the 2 most common activities that result in PM injury.Early surgical repair or reconstruction should be offered to younger, active patients with a complete PM tear; the majority of the patients undergoing surgical repair achieve good-to-excellent outcomes.Nonsurgical treatment of a complete PM tear is an option but will result in cosmetic deformity and a deficit in adduction strength of the arm. Outcomes after nonsurgical treatment of complete PM tears are less satisfactory than those obtained after surgical treatment.Currently, there is no consensus on the chronological definition of PM tears (acute versus chronic), the critical time limit for performing surgical repair, the ideal fixation device (cortical button, bone tunnel, or suture anchors), the indications for allograft use, and the ideal rehabilitation protocol after treatment of PM tears.

Pectoralis Major Muscle Belly Rupture in a 17-Year-Old Female Softball Player

“…PM tears have been reported anywhere between the muscular origin and insertion, but by far, the most common site of rupture is either the musculotendinous junction or the site of humeral insertion. Rarely, however, do they occur in the muscle belly itself, and when they do, it is primarily due to blunt trauma, not repetitive throwing as witnessed in this case 1,6,7,10,14,19,20 . Intramuscular repair presents a unique challenge to surgeons given the lack of reliable suture constructs and increased likelihood of suture pullout, making an adequate end-to-end repair difficult 21,22 .…”

“…This unequal fiber lengthening places the inferior fibers at a mechanical disadvantage when the PM is eccentrically loaded, therefore making them the first and most likely fibers to rupture 9,16 . For example, movements that extend and externally rotate the humerus such as bench pressing are well known to be the leading cause for PM injuries 1,12,17 . This case demonstrates a unique mechanism of injury, side-arm throwing, which led to a full-thickness tear of the inferior fibers as opposed to the more common acute tear pattern caused by eccentric loading of the PM during weight training.…”

“…The incidence of pectoralis major (PM) tears has greatly increased over the past 3 decades 1,2 . An overwhelming majority of reported PM tears occur in young active men, with only a few reported cases of PM tears involving women 2–6 .…”

“…An overwhelming majority of reported PM tears occur in young active men, with only a few reported cases of PM tears involving women 2–6 . In most cases, PM tears result from activities that extend, abduct, and externally rotate the humerus leading to tears commonly located at the humeral insertion or the musculotendinous junction 1,7 .…”

“…Henry A Kuechly, BS 1 Jorge Figueras, BS 1 Garrett Gordon, BS DPT 1 Brian M Johnson, MD 1 Justin W West, MD 1 Brian M Grawe, MD 1 1 University of Cincinnati College of Medicine, Cincinnati, Ohio E-mail address for H.A. Kuechly: kuechlhy@mail.uc.edu…”