Pectoralis Tendon Tear
The pectoral muscles, colloquially referred to as “pecs”, are located on each side of the sternum (breastbone) and reside under the breast or fatty tissue of the chest. There are two such muscles: the pectoralis major and the pectoralis minor.
The pectoralis major muscle is a thick, fan-shaped muscle that extends across the upper part of the chest. The muscle is composed of two parts: the clavicular head and the sternocostal head. The clavicular head originates at the clavicle and extends down the humerus (upper arm bone). The sternocostal head originates from your sternum, ribs, and external oblique muscle, and attaches to the humerus along with the clavicular head.
The pectoralis minor lies underneath the pectoralis major. It originates from the middle ribs and attaches to the shoulder blade. These muscles help you move your shoulder, and are responsible for internal rotation, forward elevation, and adduction of the arm (pulling your arm across the front of your body).
Injury to the pectoral muscle, such as a rupture or tear, can cause shoulder pain and limit the use of the arm.
In isotonic contraction (contractions that involve shortening of the muscle), muscle tension remains constant and the length of the muscle changes. There are two subtypes of isotonic contractions: concentric and eccentric. Concentric contraction is when the muscle shortens, and eccentric contraction is when the muscle lengthens.
Eccentric contraction occurs when the force applied to the muscle exceeds the force that the muscle can generate. For example, the lowering of weights during a biceps curl is a movement that employs eccentric contractions.
The injury results from a violent, sudden eccentric contraction of the muscle, and commonly presents as a sports injury. Typically, the mechanism of a pectoralis major tendon tear is such an eccentric contraction.
A severe injury can cause the pectoralis muscle to partially or completely tear. Tears are categorized by grades according to severity (the number of muscle fibers torn and how much function is lost).
- Grade 1: Overstretching of the tendon
- Grade 2: Partial tear (the most common classification)
- Grade 3: Complete tear of the pectoralis tendon
The pectoralis major tendon is usually injured during an eccentric contraction. A pectoralis major tendon tear is a relatively rare injury and is seen in athletes over 50% of the time—particularly in weightlifters performing bench presses. Other sports that can lead to this type of injury include:
- rugby
- wrestling
- water skiing
- football
- hockey
- parachuting
A pectoralis major tendon tear typically presents in male athletes aged 20 to 40. This injury can result in significant disability in athletes. While it is still uncommon, the number of cases has risen over the past 30 years, which coincides with an increase in recreational and professional athletes.
Symptoms include weakness, pain in the upper chest and arm, and deformity of the upper chest and arm. Patients often report hearing or feeling a “pop” or tearing sensation. Other symptoms include:
- sudden and severe pain at the time of the injury (localized to the chest and front of the shoulder, but may radiate into the upper arm or neck)
- tenderness upon palpation
- swelling
- limited range of motion (difficulty moving the arm inward or across the body)
- asymmetrical/abnormal contour of the chest and upper arm
- bruising of the chest
Chronic tears of pectoralis major can cause a decrease in muscle mass.
In the acute phase of the injury, swelling and pain may distort the shoulder and affect strength and motion testing. Once the swelling has subsided, diagnosis of a pectoralis major tendon tear can typically be made through a physical examination. You may notice bruising, swelling, and abnormality of the chest and upper arm.
X-rays may be used to look for an associated fracture or bone fragment on the tendon, but more commonly, an MRI scan will be ordered. This imaging test can be used to confirm the diagnosis, determine the site, and classify the injury by grade. Since ultrasound images are low cost and readily available, they may be useful in identifying tears, although MRI is considered the most appropriate imaging modality.
The grade and location of the tear, as well as the patient’s age, activity level and desired outcome will play a role in choosing the best treatment. In patients who have low activity levels, nonsurgical treatment options such as rest, ice, immobilization and range of motion exercises may provide acceptable to excellent results. Typically, surgery is recommended for most younger patients or laborers. For athletes who wish to return to their sport, surgical treatment may be the best option.
In cases of chronic tendon tears that are retracted, a reconstruction is often needed.
Dr. Ajay C. Lall is a former dual sport NCAA collegiate athlete (football and track & field), American board certified, triple fellowship-trained expert orthopedic surgeon who specializes in hip arthroscopy, robotic hip replacement and cutting-edge regenerative medicine such as platelet-rich plasma (PRP) and Stem-Cell therapy. He treats non-athletes and athletes at all levels of play from collegiate to professional to the Olympic level. Dr. Lall is a world-renowned orthopedic surgeon who cares for all patients like family. Contact LALL Orthopedics + to schedule a consultation, receive the correct diagnosis, and undergo state-of-the-art treatment options.
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Ajay C. Lall, MD, MS, FAAOS
- Board Certified – Orthopedic Surgery
- Triple Fellowship Trained
- Performs over 750 Surgeries Per Year
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