A rupture of the pectoralis major tendon is an extremely painful injury to the chest wall and upper arm of athletes. It is typically seen in bodybuilders and weightlifters who notice severe pain and a tearing sensation during a bench press or other weightlifting motion. It can also be seen in athletes of contact and collision sports, such as football players, when their arms are traumatically forced out and away from their bodies.
Diagnosis by a sports medicine physician is usually fairly straightforward. Physical examination soon after the injury will reveal a defect in the upper chest wall as well as significant swelling and bruising. The athlete will often have pain when the physician turns or pulls the arm away from the body. The athlete usually has a tremendous amount of pain and weakness trying to internally rotate the shoulder across the body or pull the arm down by his side against resistance. X-rays are usually normal. An MRI can be helpful to determine the location of the injury, meaning whether or not the tear is within the muscle belly of the pectoralis major, at the junction between the muscle and tendon, or the tendon is pulled off of the bone.
Partial tears of the pectoralis tendon or tears within the muscle belly of the pectoralis major can be treated without surgery. Rest and use of a sling for comfort can help the injury heal. Return to activities of daily living is usually successful, although many patients with these injuries still complain of weakness months and years after the injury occurs. Complete tears of the tendon off of bone are usually treated with surgical repair. The surgery is usually an outpatient procedure. A small incision is made on the upper arm where the tendon attaches. Sutures are placed within the tendon, and the sutures are pulled down to anchors placed in bone where the tendon attaches. As with most tendon repairs, the surgeon has to get the repaired tendon to heal in that position. Therefore, the athlete is kept in a sling for several weeks to protect the repair.
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Physical therapy after surgery is a lengthy process. Initially the goal is to gently increase shoulder range of motion without putting too much stress on the repair. Any strengthening of the pectoralis major muscle is avoided initially to prevent stress on the tendon. As the healing progresses over many weeks, full motion is restored and strengthening is gradually increased. Weight lifting and sports are usually avoided for the first few months after surgery. As the tendon heals and motion of the shoulder is restored, certain weightlifting movements are gradually started. Full return to weights and sports can take 4 to 6 months, if not longer.Shoulder Injuries
Biceps ruptures (proximal)
Distal Clavicle Osteolysis
Glenohumeral Internal Rotation Deficit (GIRD)
Internal Impingement of the Shoulder
Little Leaguer’s Shoulder
Pectoral Tendon Rupture
Rotator Cuff Injuries
Superior Labral (SLAP) Tears