8/12/2019 Pectoralis Maior Ruptures
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The Pectoralis major is a very powerful muscle that forms the
chest prominence and. It moves theshoulder forwards and across your
chest. It is best known as the muscle that you develope with
thebench press exercise.
The pec major attaches to the humerus bone (upper bone of arm)
and is divided into two parts. Theupper part is known as the
'clavicular head' and the lower part the 'sternal head', based on
their originsfrom the clavicle and sternal bones repsectively.
Ruptures of the pectoralis major muscle are becoming more common
due to the increase in power sportsweight training. It most
commonly occurs during bench pressing and is felt as a painful snap
at the frontof the shoulder and chest. The muscle then 'bunches up'
and deforms. Bruising and swelling is common.
The Pectoralis major may tear/rupture in the following parts of
the muscle:
1. tendon rupture off the humerus bone (most common)2. Tear at
the junction of the muscle and tendon (musculo-tendinous
junction)3. Tear within the muscle belly itself4. Muscle tearing
off the sternum (very rare)5. Treatment:6. The pec major muscle is
not essential for normal daily shoulder function, but is important
forsrenuous activities. Patients who wish to return to active
athletic and manual activities are likely
to benefit from surgical repair.7. 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-injurystrength and return to
activities, than patients managed conservatively [ Bak et al. ] .
Outcomestudies comparing conservative with surgicaltreatment have
demonstrated that surgically repaired injuries regained 97% of the
strength ofthe uninjured arm vs. 56% in non-operative patients [
Hanna et al . ].
8. 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 complicationsincreases as a result of
significant scarring and retraction of the muscle. Some of my
resultswere published in 2009 [ Shah et al. TSES, 2009 ] .
9. For delayed and chronic ruptures reconstruction can be
considered. This is done usinga tendongraft. We have found Achilles
tendon Allograft to be the strongest and mostreliable tendon graft.
For information on tendon allografts click here .
The decision on which pec major tears to repair and when depends
on the type of tear, how oldit is, how retracted it is, the demands
and requirements of the patient and the expertise of thesurgeon.The
common types I see are:Acute (< 3 months)
- tendon avulsion = repair as soon as possible directly to the
bone- Musculo-tendinous tear = I prefer to wait for consolidation
of the scar tissue and then reef
the muscle-tendon junction with a special high strength suture
material that encourageshealing (Orthocord). (you cannot repair
muscle directly, therefore wait for some fibrous tissueeither side
of the tear)
- Muscle tear = extremely rare and almost impossible to repair,
but can do as above and
reinforce with achilles tendon allograft.Chronic (> approx. 3
months):
- tendon avulsion - if retracted lateral to nippple line usually
can still do a direct repair; ifretracted medial to nipple line
needs a tendo-achilles allograft reconstruction- Musculo-tendinous
& muscle tear - reef repair using high strength biological
suture, like a
hernia repair.
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