There are two types of Pectoralis Muscle known as Pectoralis Major and Pectoralis Minor. The Pectoralis Major muscle is the larger of the two muscles. Pectoralis Major muscle lies in front of chest wall on both the side over the rib cage. Pectoralis Major Rupture or Tear is rare injury. Contractions of Pectoralis Major Muscles facilitate movement of arm across the chest.
What Is Pectoralis Major Rupture?
- The Pectoralis Major as stated is a muscle located in front of the chest wall and lies on the surface of anterior rib cage.
- Pectoralis Major Muscle facilitates movement of the arm in front of the chest. The functions like Bench press or moving upper arm across the chest wall is accomplished by contraction of Pectoralis Major Muscle.
- This pectoralis major muscle or rupture of tendon of pectoralis major muscle is rare but often occurs as a spontaneous injury in elderly patient or injury caused by contact sports and automobile or car accident. 1
- Tendon is a bundle of thick fibrous tissue, which connects muscles to the bones. Tendon rupture causes severe pain in chest wall often mistaken for heart attack.
- Pectoralis major tear is classified as complete and partial tear. The classification also includes tear of muscles and tendon. The complete tear of muscle mass is most common injury.2
Causes of Pectoralis Major Rupture
- Spontaneous Rupture– Spontaneous rupture or tear is rare but seen in elderly patients. Injury follows prolonged inactivity resulting in muscle atrophy. Sudden attempt to use the muscle for forceful action results in rupture of pectoralis muscle.
- Weight Lifting– Heavy weight lifting often causes tear or rupture of pectoralis major muscles or tendon.
- Sports Injury– Repetitive action of upper arm causes fatigue and overuse of the pectoralis major muscle. Playing tennis or throwing baseball repeatedly can cause pectoralis major muscle tear or rupture. There are several sports like wrestling or rugby that can cause severe pectoralis major muscle injury.
- Chronic Use of Corticosteroids– Use of corticosteroids can also contribute to Pectoralis Major Rupture as steroid use tends to weaken the tendons and muscles.
Symptoms of Pectoralis Major Rupture or Tear
- Pain– Patients complain of anterior chest wall pain. Pain is often severe and sharp often thought as cardiac or heart pain when present on left side. Pain becomes severe following examination of pectoralis major muscles because of pressure applied by the examiner over the injured muscles.
- Muscle Weakness– Tear of muscle or tendon causes loss of link between two torn section of muscles or tendon. The muscle pain follows muscle guarding and individual prevents contraction of the muscles by avoiding certain arm movements, which may provoke pain. Loss of link between torn segment of muscle or ligament causes weakness in the muscle.
- Bruising and Chest Wall Swelling– The muscle injury causes bleeding from torn muscle mass and blood collects under the skin in subcutaneous tissue resulting in purple discoloration and bruising. Tear of tendon causes less bleeding than muscle tear. The bruising is observed over the torn muscles.
Diagnosis of Pectoralis Major Rupture
- The finding like pain, swelling, bruising, purple discoloration of the skin and tenderness suggest pain is caused by disease in muscle mass. In addition examination also helps to evaluate asymmetry of chest wall between injured and uninjured side.
- X-Ray– X-Ray examination is performed to rule out fracture of ribs or sternal skeletal injury.
- MRI Examination– MRI examination suggests soft tissue injury and muscle or tendon injury. MRI is also used to rule out fracture or dislocation of the ribs.
- Bleeding Time– Bleeding and coagulation studies are performed to rule out bleeding disorder.
- Hemoglobin– Hemoglobin study indicated the amount of blood loss following torn muscle mass in the subcutaneous tissue.
- Ultrasound examination helps to find the spread of blood clot and subcutaneous bleeding. Ultrasound also helps to study detailed view of the torn ligament and muscle.3
Treatment For Pectoralis Major Rupture
Non-surgical Treatment For Pectoralis Major Rupture or Tear-
- Cold Therapy or Cold Pack-
- Cold therapy prevents further bleeding by causing contractions of blood vessels. Cold therapy reduces edema and also reduces the pain. Cold pack is left over the wounded muscle for 30 minutes and repeated every 4 hours.
- Restriction of Movements of Arm-
- Movement of the arm causes severe pain over the Pectoralis Major Muscles. The arm movement is restricted by using sling around the arm and chest.
- NSAIDs– NSAIDs are anti-inflammatory known as non-steroidal anti-inflammatory drugs. NSAIDs are used for inflammation and pain.
- Opioids– Opioids are used for chronic pain, which is not responding to NSAIDs. Severe pain is most often treated with opioids. Opioids prescribed for severe pain are Hydrocodone (Vicodin or Norco) and Oxycodone (Percocet).
- Muscle Relaxants– Tear or rupture of pectoralis major muscle or tendon causes spasm of surrounding muscles. Prolonged muscle spasm causes muscle fatigue and severe pain. Muscle spasm is treated with muscle relaxants. Muscle relaxants used to treat muscle spasm is Baclofen, Skelaxin and Flexeril.
- Physical Therapy-
- Physical therapy is used to prevent muscle atrophy of the surrounding muscles in arms and chest wall.
- Physical therapy is also used for post surgical rehabilitation.
Surgical Treatment For Pectoralis Major Rupture or Tear-
- The torn muscle end are sutured together by heavy suturing threads.4
- The preliminary surgery may often fail resulting in separation of segments.
- The re-tear is treated using special surgical technique known as “Endbutton Suturing Technique”.5
Exercises For Pectoralis Major Tendon Rupture
Static Pectoral Push-In: Start the exercise in a standing position with the back and neck straight and the shoulders a bit backwards. Keep the elbow at the side and bent at 90 degrees and push the hand against the other hand’s resistance as hard as possible without increasing the pain. Hold for about 5 seconds and do it at least 10 times.
Shoulder External Rotation: Start by standing tall with the neck and back straight and the shoulders a bit back slightly. Keeping the elbow tucked on the side and bent at 90 degrees slowly take the hand away from the body as far as possible without increasing the pain. Do this at least 10 times.
Shoulder Flexion: Start by standing tall with back and neck straight. Now, slowly raise the arm forwards and upwards as far as possible without increasing pain. Do this for about 10 times.
Prevention of Pectoralis Major Rupture
Weightlifters need to be instructed on appropriate techniques for doing bench press. An important consideration is to limit the distance to which the bar is lowered and also narrow the grip of hands to bar.
- Regarding “A systematic review and comprehensive classification of pectoralis major tears”.Guiu R, Lefort H, Mihai I, Ernouf C, Domanski L. J Shoulder Elbow Surg. 2013 Feb;22(2):e22-3.
- Pectoralis major ruptures. Potter BK1, Lehman RA Jr, Doukas WC. Am J Orthop (Belle Mead NJ). 2006 Apr;35(4):189-95.
- Distal pectoralis major tears: sonographic characterization and potential diagnostic pitfalls. Lee SJ1, Jacobson JA, Kim SM, Fessell D, Jiang Y, Girish G, Magerkurth O. J Ultrasound Med. 2013 Dec;32(12):2075-81.
- Clinical results of a surgical technique using endobuttons for complete tendon tear of pectoralis major muscle: report of five cases. Uchiyama Y1, Miyazaki S, Tamaki T, Shimpuku E, Handa A, Omi H, Mochida J. Sports Med Arthrosc Rehabil Ther Technol. 2011 Sep 28;3:20.
- Surgical approach to acute pectoralis major tendon rupture. Merolla G1, Campi F, Paladini P, Porcellini G. G Chir. 2009 Jan-Feb;30(1-2):53-7.