tears of the pectoralis major muscle are becoming increasingly more common as a result of greater participation in bodybuilding and weightlifting training.
the pectoralis major is a large and
powerful muscle located on the upper front part of the chest.
it causes the arm to rotate inward and move closer to the body.
it originates from the the collar bone and breast bone and attaches onto the humerus bone.
consisting of two sections : the clavicular portion and the sternal portion
a pectoralis major rupture includes either a partial, some of the tendon is torn and some is still intact.
or a full thickness tear of muscle or tendon.
injury of the pectoralis major can occur at the muscle origin , very rare,muscle belly,junction of the muscle and tendon,
intra-tendinous region or humeral insertion with or without bone avulsion , it is the most common.
causes:
a pectoralis major strain typically occurs when the muscle is forcibly contracted whilst in a stretched position.
or when a force goes through the muscle and tendon that is greater than they can withstand.
this can occur during weight training when performing bench press,
or chest press exercises.
it can also occur in other high-impact sports such as wrestling and boxing.
or less commonly, as a result of severe trauma such as a fall onto an outstretched arm in accidents.
it is known that anabolic steroid use can weaken the tendon and this is thought to be a contributing factor in many pectoralis major muscle ruptures in bodybuilders and weightlifters.
symptoms:
an audible pop in the chest or shoulder at the time of the injury.
pain in the front of the shoulder .
difficulty lifting the shoulder and arm.
bruising or swelling in the front of the shoulder or in the chest or arm.
distorted shape in the front of the
chest on the affected side.
diagnosis:
your doctor will ask you how your pain and limited
motion started.
usually your description of the mechanism of your injury and your symptoms will lead your physician to suspect your pec has torn.
he will carry out a deep physical examination .
x-rays should be taken to look for a possible bone fragment on the tendon or other associated fracture or dislocation .
ultrasound can be useful to assess the presence of a tear or retraction of the tendon due to its relatively low cost and rapid availability.
magnetic resonance imaging (MRI) is considered the imaging modality of choice.
it can help to determine the site and extent of injury and differentiate between acute or chronic , complete or partial tears.

treatment:
non-surgical treatment must be considered in patients who are elderly or have either partial tears or tears in the muscle belly.
your doctor may require that you wear a sling.
the sling helps to keep your upper arm and shoulders still to allow healing.
typically a sling is worn for four to eight weeks.
you may use ice to help control the pain and to decrease swelling around your shoulder and chest.
ice should be applied for 10 to 15 minutes several times each day.
the doctor may recommend painkillers and muscle relaxants.
physiotherapy is very important in the treatment of a pectoralis major tears.
it will likely start about three to four weeks for
partial tears.
a complete tear requires a bit more rest and immobilization so your physical therapy will start about six weeks after the injury.
you will attend physiotherapy for four to eight
weeks.
you can relax the pectoralis muscle with ribcage self-massage.
symptoms such as pain and limited mobility often improve as a result.
surgical treatment:
the treatment of choice for complete tears is generally operative.
the decision on which pec major tears to repair and when depends on the type of tear,how old it is,how retracted it is,and the demands and requirements of the patient.
for acute tears less than three months:
tendon rupture: repair as soon as possible .
in musculotendinous tears: you cannot repair muscle directly therefore wait for some fibrous tissue either side of the tear.
muscle belly tear: extremely rare , and almost impossible to repair but can wait for some fibrous tissue either side of the tear and reinforce with tendon graft.
for chronic tears greater than approximately three months:
in tendon tear if retracted lateral to nipple line usually can still do a direct repair.
if retracted medial to nipple line needs a tendon graft reconstruction.
musculotendinous and muscle tear: repair using high
strength suture or reinforce with tendon graft.
post-operative rehabilitation.
the arm is kept in a sling for four to six weeks depending on the type of repair and the tear pattern to protect healing repaired tissue.
passive pendulum exercises are begun immediately.
move your arm in a clockwise circle,
then in counterclockwise circle.



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