Access Keys:
Skip to content (Access Key - 0)

Pectoralis major rupture

Introduction

Define/describe the condition

Anatomy

The fascia overlying the pectoralis major is continuious with the medial brachial fascia. Pectoralis major has two heads: the clavicular and sternal. The muscle inserts on the lateral aspect of the biceipital groove. The fibers from the sternal head twist 180 degrees so that the superior-most fibers at the origin insert at the inferior aspect of the bicipital groove and the the inferior-most fibers at the origin ultimately insert at the superior aspect of the groove. Thus, the pec major tendon has been described as bilaminar (howerver, it has also been decribed as trilaminar). The insertion site is 4-6 cm in length and 5mm in width. In the bilaminar description, the anterior portion of the tendon is 1 cm long and the posterior 2.5 cm long. The clavicular head and medial portion of the sternal head is innervated by the lateral pectoral nerve (C5 - C7) and the lateral portion of the sternal head by the medial pectoral nerve (C8 - T1). The nerves pierce the muscle from the medial and inferior aspects. The pectoral branch of the thoracoacromial artery provides the blood supply. The muscle adducts, internally rotates and forward flexes the humerus.

Pathogeneis

Describe the biologic basis of the disorder or the mechanism of injury

Natural History

 Most traumatic tears occur in weight lifters between the ages of 20 and 40 years from bench pressing (during eccentric contraction). No tears have been reported in females secondary to a sports injury.

Patient History and Physical Findings

Weakness in adduction, chest wall asymmetry, ecchymosis, pain with passive abduction.

Imaging and other Diagnostic Studies

MRI is useful in making the diagnosis. Plain X-rays and CT are of limited use with the exception of injuries with bony avulsions.

Descriptive classification:

  • Extent of tear
    • Partial (X%)
    • Complete
  • Location of injury
    • bony avulsion from proximal humerus
    • rupture at bone-tendon junction
    • rupture at musculotendinous jucntion
    • rupture in muscle belly

Tietjen classification:

  • Type I: Contusion or sprain
  • Type II: Partial tear
  • Type III: Complete tear at:
    • A: muscle origin
    • B: muscle belly
    • C: myotendinous junction
    • D: tendon

Differential Diagnosis

  • Poland's Syndrome - congential absence of the pectoralis major
  • Biceps tendon tear

Treatment

Nonoperative treatment Indications:

  • Injuries in muscle belly and even the musculotendious junction are difficult to repair and are best managed conservatively.
  • Partial tears
  • Elderly low-demand patients
  • Low demand patient in nondominant arm

Operative treatment indications:

  • Complete tears
  • Active, high-demand patient
  • Tears at bone-tendon interface

Operative techniques:

  • Repair into a bone trough lateral to the bicipital groove
  • Use of suture anchors at the insertion site
  • Chronic tears by require a bridging graft (e.g. achilles tendon allograft, hamstring autograft)

     

 

Pearls and Pitfalls

Acute tears (< 6 - 8 weeks old) are generally technically easier to repair and have better outcomes.

Postoperative Care

After nonoperative management:Short term immobilization followed by progressive range of motion over 6 weeks followed by gradual strengthening. Return to light weight lifting with modified techniques at 10 - 12 weeks. Return to sport when patient has full range of motion and is pain free.

Ater operative management: immobilization for 2-3 weeks; Progression to full range of motion by 6 weeks. Light resistance training beginning at 6 weeks. Full activity at 4 - 6 months if goals met (full range of motion, painless resistance exercises, strength approximating the uninjured side).

Outcome

A recent prospective study (n = 20) comparing surgical to nonsurgical management reported that isokinetic testing revealed a decrease in strength of 53.8% in the nonsurgical group and 13.7% for the surgical group .

Complications

Include overview of complications

Selected References

DeLee, Jesse C., David Drez Jr., and Mark D. Miller, eds. DeLee & Drez's orthopaedic sports medicine principles and practice. 3rd ed. Vol. 1. Philadelphia: Saunders/Elsevier, 2010.

Peer Review

OrthopaedicsOne Peer Review Workflow is an innovative platform that allows the process of peer review to occur right within an OrthopaedicsOne article in an open, transparent and flexible manner. Learn more

Instructions for Authors

Read our Instructions for Authors to learn about contributing or editing articles on OrthopaedicsOne.

Content Partner

Learn about becoming an OrthopaedicsOne Content Partner.

Academic Resources

Resources on Pectoralis major rupture from Pubget.

Error rendering macro 'rss' : The RSS macro is retrieving an HTML page.
Orthopaedic Web Links

Internet resources validated by OrthopaedicWebLinks.com

Related Content

Resources on Pectoralis major rupture and related topics in OrthopaedicsOne spaces.

Page: Tibial shaft stress fracture (OrthopaedicsOne Articles)
Page: Head injuries (OrthopaedicsOne Articles)
Page: Neck injuries (OrthopaedicsOne Articles)
Page: Burners and stingers (OrthopaedicsOne Articles)
Page: Heat stroke (OrthopaedicsOne Articles)
Page: Herniated disc (OrthopaedicsOne Articles)
Page: Lumbosacral sprains (OrthopaedicsOne Articles)
Page: Thoracolumbar sprains (OrthopaedicsOne Articles)
Page: Exercise science (OrthopaedicsOne Articles)
Page: Preparticipation exams (OrthopaedicsOne Articles)
Showing first 10 of 234 results