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Pectoralis Major Rupture

What is it?

The Pectoralis major is a very powerful muscle that forms the chest prominence and. It moves the shoulder forwards and across your chest. It is best known as the muscle that you develope with the bench press exercise. 

The pec major attaches to the humerus bone (upper bone of arm) and is divided into two parts. The upper part is known as the 'clavicular head' and the lower part the 'sternal head', based on their origins from the clavicle and sternal bones repsectively.

Ruptures of the pectoralis major muscle are becoming more common due to the increase in power sports weight training. It most commonly occurs during bench pressing and is felt as a painful snap at the front of the shoulder and chest. The muscle then 'bunches up' and deforms. Bruising and swelling is common.

Left pec major rupture. Note bruising and asymmetrical chest

Rupture of the sternal and clavicular parts of the Pec Major, with the muscle retracted, giving the 'bunched-up' appearance on the outside

Treatment:

The pec major muscle is not essential for normal daily shoulder function, but is important for srenuous activities. Patients who wish to return to active athletic and manual activities are likely to benefit from surgical repair.

A large statistical review (meta-analysis) of 112 cases of pectoralis major rupture, patients who undergo surgical repair have significantly decreased pain, as well as a higher rate of pre-injury strength and return to activities, than patients managed conservatively [Bak et al.]. Outcome studies comparing conservative with surgical
treatment have demonstrated that surgically repaired injuries regained 97% of the strength of the uninjured arm vs. 56% in non-operative patients [Hanna et al.].

The earlier a repair is performed the easier the surgery and the better the outcome of surgery. Outcomes after early primary repair have generally been superior to those of delayed repair [Aarimaa et al. and Bak et al]. When surgery is delayed, the risk of failure and complications increases as a result of significant scarring and retraction of the muscle.

For delayed and chronic ruptures reconstruction can be considered. This is done using a tendon graft. We have found Achilles Tendon Allograft to be the strongest and most reliable tendon graft.
For information on tendon allografts click here.

Surgery for Pec Major Tear

For more information on the surgery click here (please note that the page includes surgical photographs, which may offend some viewers)

You should not eat or drink anything after midnight the night before the procedure.

You will usually be in hospital for no more than one day. 

A doctor/physiotherapist will see you prior to discharge and you will be taught exercises to do and given further advice to guide you through your recovery.

Your arm will remain in a shoulder sling for at least 3 weeks. For more details on Living with a Shoulder Sling Click Here

The length of time that you will be off work will depend on your job but expect a minimum of 6 weeks if work involves heavy duties.

Physiotherapy will be organised for when you leave hospital and may well continue for some months after the surgery.

You will be guided through the rehabilitation programme by your physiotherapist. It is of the utmost importance that you stick strictly to this programme.

Click here for the Post-operative rehabilitation Protocol

 Related Articles
Also See:

• Patient Experiences:
  • Primary Repair
  • Revision Repair
  • Allograft Reconstruction
• Pec Major reconstruction  in Athletes

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If you are interested in making an appointment to discuss a treatment,
please click here to contact us, or telephone 0161 227 0027.