Pectoralis Major Tears
The pectoralis major muscle is the large muscle just in front of the chest wall. There are two parts of the pectoralis muscle, the pectoralis major and the pectoralis minor. The pectoralis major is the larger of the two, and works to push the arms in front of the body, such as in a bench pressing.
The most common injury seen with this muscle is that its tendon (that attaches to the arm bone or humerus), can rupture. This is commonly known as a pec rupture. The injury occurs almost exclusively in men that are active with weight training or high impact sports. Partial tears can occur, although they are less common. It is important to have your doctor make that distinction early as a missed tear can be more difficult to repair.
These injuries typically occur during forceful activities. Interestingly, almost half of all pectoralis ruptures occur during weightlifting, especially while bench pressing high weights. Other causes include football injuries, wrestling, rugby, and other significant traumatic injuries.
Steroid use may also weaken the tendon, and this is thought to be a contributing factor in many pectoralis major muscle ruptures. Especially as they typically involve body-builders in many cases. Having said that, these injuries can certainly occur in patients who have never used steroids.
Patients who experience a pectoralis major rupture feel sudden pain, and sometimes they hear a rip and tearing sensation in their chest. Symptoms include local pain in the chest and upper arm as well as weakness in pushing the arms out in front of the body
Several days later, there may be bruising in the chest and arm which can be significant. Once the swelling and bruising go away, dimpling or an obvious defect in the muscle may be noticed. Most commonly, however, this deformity is not noticed for several weeks as a result of the local swelling that is formed from the injury. The doctor that evaluates the area should have a high degree of suspicion about the injury and order immediate studies such as an MRI.
In the picture above, the typical dimpling of the skin and atrophy are obvious on the left side.
Surgery is most often recommended for complete tears of the tendon. However, there are several types of tears that have been classified as four types and they are:
Type I: A rupture of the humeral insertion (tendon tears from bone)
Type II: A rupture of the junction of the muscle to the tendon
Type III: A rupture of the muscle belly (rupture in the muscle itself)
Type IV: A rupture of the muscle off the chest wall (rare injury)
In most cases, the ruptures at the humeral insertion are fully torn and type II and III ruptures are often partial ruptures. Patients who have partial tears, tears within the muscle, or elderly and low-demand patients, may be able to avoid surgical treatment altogether.
Active and younger patients are typically recommended to undergo surgery for the tear. This allows patients to have a good chance at returning to high-level sports and activities without any weakness. Ideally the repair is performed in the early period following the injury. By performing the repair within several weeks of the injury, scar tissue and muscle atrophy are minimized. Placing large sutures in the torn tendon, and then securing these sutures to the arm bone with either holes in the bone or anchors inserted in the bone perform the repair.
In some situations, good results can be obtained with a repair that is performed months, or even years, following the injury. Ideally the repair can be done in a timely fashion, but there are studies that show patients who have late repairs can find improved appearance of the chest, strength, and overall satisfaction.
The most important preventative issue is that weight lifters should be instructed on proper bench press technique. Most importantly, is to limit the distance that the bench bar is lowered. Narrowing the grip of the hands on the bar will also help. With lowering the bar all the way to the chest, and/or widening the grip on the bar, increases the stress on the muscle and the possibility of pectoralis injury.