Pectoralis major tendon tears, particularly in weightlifters, can significantly impact strength and appearance. When the tendon is torn, the ability to push off with the arm is severely reduced, and the chest wall may develop a noticeable deformity. While recent tears are generally straightforward to repair, older injuries pose a greater surgical challenge due to muscle atrophy and loss of elasticity over time. However, even chronic tears can often be successfully addressed with advanced surgical techniques.
Modern surgical approaches aim to restore strength by reattaching the torn tendon or muscle back to the bone, sometimes with the use of allograft tissue. These procedures also focus on recreating chest wall symmetry by mobilizing shrunken muscles and reconstructing the pectoralis tendon. Aesthetic considerations, such as hiding scars within natural skin creases and minimizing adhesions, are also integral to achieving optimal results.
This article explores the causes, symptoms, and surgical solutions for pectoralis major tendon tears, including techniques for addressing both acute and chronic injuries. With the right approach, it is possible to improve chest deformity, regain strength, and return to daily activities with confidence.
What is the Pectoral Muscle, and Where is it Located?
The pectoral muscle is a large, powerful muscle located at the front of the chest. It is one of the primary chest muscles responsible for internal rotation of the arm and bringing the arm closer to the body. The pectoral muscle originates from two points: the sternum (breastbone) and the clavicle (collarbone).
These two groups of the pectoralis major muscle attach just below and in front of the shoulder, on the outer part of the biceps tendon, and connect to the humerus (upper arm bone). Nearly all pectoral muscle injuries occur where the tendon attaches to the bone.
How Does a Pectoral Muscle Tear Occur?
Pectoral tears most commonly occur in male athletes during weightlifting, especially while performing the bench press exercise. During bench press, when the weight is near the chest, the pectoralis major muscle reaches its maximum length. When the athlete attempts to lift the weight, the pectoralis major muscle contracts. This is called eccentric contraction. A pectoral muscle tear occurs at this exact moment. While bench press is a common cause, pectoral muscle injuries can also happen during other sports activities. Pectoral tendon tears are most common in men aged 20 to 40.
Where Do Pectoral Muscle Tears Occur?
Type 1: Tear at the site where the pectoralis major tendon attaches to the humerus (most common injury).
Type 2: Tear at the muscle-tendon junction.
Type 3: Tear within the muscle itself (rare).
Type 4: Tear of the muscle from the sternum (rare).
Symptoms of Pectoral Muscle Tears
Pain: The most common symptom of a pectoral tear is sudden, sharp pain in the front of the shoulder, where the pectoral tendon attaches. Patients may also experience swelling and tenderness in the chest area.
Popping Sound: A popping sound may be heard at the time of injury.
Bruising: Bruising can appear in the arm and chest area a few days after the injury. Due to gravity, bruising is often observed lower, around the elbow.
Deformity: If untreated, a deformity in the chest area may develop a few months after the injury. Initially, swelling may mask the deformity, but it becomes evident as the swelling subsides.
Movement Difficulty: Patients often experience difficulty moving their arm in the first days after the injury.
Weakness: Patients with a torn pectoral tendon exhibit significant weakness in adduction and internal rotation of the arm.
How is a Pectoral Muscle Tear Diagnosed?
Diagnosing a pectoral muscle tear is not challenging, even in the acute phase, during physical examination. In most cases, the injured muscle’s shape and volume visibly differ from the uninjured muscle. In my practice, I use ultrasound imaging as part of the physical examination for pectoralis major injuries. However, MRI imaging remains the gold standard for a definitive diagnosis, as it precisely identifies the location of the tear.
Treatment of Pectoral Muscle Tears
Most cases of pectoral muscle injuries require surgical treatment. The torn tendon is reattached to the bone. Pectoralis major repair surgery allows patients to fully return to sports activities.
Pectoral Tear Surgery
There are two types of surgeries for pectoral muscle tears:
Pectoral Muscle Repair Surgery:
For fresh tears, the torn tendon is accessed by making an incision between the pectoral and deltoid muscles. The tendon, detached from the bone, is secured to the humerus using 2-3 sutured anchors. This method is known as primary repair.
Pectoral Muscle Reconstruction Surgery
When significant time has passed since the injury, the tendon may shorten, making repair surgery difficult. In such cases, reconstruction surgery is performed. If more than a month has passed since the injury, a reconstruction procedure is planned. During the reconstruction surgery, the torn tendon and muscle are sutured to an Achilles tendon graft obtained from a tissue bank. The Achilles tendon is then anchored to the humerus with special screws.
Regardless of the time elapsed, chronic pectoral muscle injuries can often be repaired using the reconstruction method.
Rehabilitation Process After Pectoral Tear Surgery
Weeks 0-3: The patient wears a sling and avoids external rotation of the arm.
Weeks 3-6: The sling is continued. By the end of the sixth week, exercises aiming for 30 degrees of external rotation are initiated. Shoulder extension is not allowed. Forward flexion up to 90 degrees is permitted.
Weeks 6-12: The sling is discontinued. The goal is to restore full range of motion in all directions for the shoulder joint.
Weeks 12-24: Strengthening of the pectoral tendon begins. By the end of the sixth month, the patient can perform bench press exercises.
If you suspect a pectoral muscle injury, feel free to contact our clinic for a detailed assessment and treatment options.
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