Pectoralis Major Tear
What Is the Anatomy of the Pectoralis Major?
The pectoralis major is a large, fan-shaped muscle located at the front of the chest. It has two main parts: the clavicular head, which originates from the collarbone, and the sternocostal head, which arises from the breastbone and upper ribs. Both heads converge into a single tendon that inserts into the upper humerus (arm bone). The pectoralis major is responsible for bringing the arm across the body (adduction), rotating it inward, and assisting in pushing and lifting movements.
How Does a Pectoralis Major Tear Occur?
A pectoralis major tear usually occurs when the muscle is forcefully contracted while being stretched, commonly during activities such as weightlifting (particularly bench pressing), contact sports, or trauma. The injury often occurs at the tendon insertion on the humerus, though it can also occur within the muscle or at the junction between the muscle and tendon.
Contributing factors include fatigue, poor lifting technique, or use of anabolic steroids. Patients often feel a sudden pop, tearing sensation, or pain in the chest or upper arm, sometimes followed by bruising and weakness.
What Is the Long-Term Consequence of Having a Pectoralis Major Tear?
If not treated appropriately, a pectoralis major tear can result in:
Persistent weakness with pushing, lifting, or throwing activities.
Cosmetic deformity, such as loss of the chest contour or visible asymmetry.
Chronic pain or tightness in the chest.
Difficulty performing athletic or work-related activities that require power or control of the arm.
How Does a Pectoralis Major Tear Get Diagnosed?
Diagnosis is based on the patient’s history, clinical examination, and imaging:
History of a sudden tearing sensation or pop in the chest during activity, followed by pain, swelling, or bruising.
Physical examination may reveal loss of the anterior axillary fold, asymmetry of the chest contour, weakness during adduction or internal rotation, and bruising extending into the upper arm.
MRI is the gold standard for confirming the diagnosis, showing the location and extent of the tear (partial or complete) and degree of tendon retraction.
What Are the Indications for Treating a Pectoralis Major Tear Non-Operatively?
Non-operative management may be appropriate in the following situations:
Partial tears with minimal loss of strength or function.
Elderly or low-demand patients not engaged in heavy lifting or sports.
Patients with significant medical conditions making surgery unsafe.
Tears which can not be repairs (ie extremely retracted or musculotendon junction tears).
Treatment typically includes rest, physiotherapy to restore strength and motion, and a gradual return to activity once pain subsides. Non-operative care may result in mild weakness or deformity but is suitable for those with limited functional demands.
What Are the Indications for Treating a Pectoralis Major Tear Operatively?
Surgical repair is generally recommended for:
Complete tendon ruptures, particularly in young or active individuals.
Significant loss of strength or functional limitation.
Cosmetic concerns due to visible deformity.
Failure of non-operative management to restore function.
Surgery involves reattaching the torn tendon to the humerus using sutures or anchors. Early repair (within the first few weeks after injury) typically yields the best outcomes, restoring strength, contour, and shoulder function. Postoperative rehabilitation includes a period of immobilisation followed by physiotherapy to gradually regain motion and strength.
