PEC TEAR  

Rupture of the pectoral muscle!

Pectoralis major rupture


The pectoralis major muscle is the large muscle in front of the chest wall. There are two parts of the pectoralis muscle, the pectoralis major and the pectoralis minor. The pectoralis major is the larger of the two, and works to push the arms in front of the body, such as in a bench press exercise.

The pectoralis major muscle, or most commonly its tendon that attaches to the arm bone (the humerus), can rupture. Athletes commonly call this a "pec tear" but it is more accurately called a pectoralis major muscle rupture. Pectoralis major ruptures are "uncommon" (we noticed that they are not as uncommon as most authors think!) injuries that occur almost exclusively in men between the ages of 20 to 50. While partial tears can occur, these are less common, and usually a complete rupture of the tendinous attachment of the muscle to the bone occurs.

There are 4 types of pectoralis ruptures:
type 1: rupture at the humeral insertion (tendon ruptured from the bone)
type 2: rupture at the musculotendinous junction (rupture in between tendon and muscle),
type 3: rupture of the muscle belly (rupture in the muscle itself).
type 4: Muscle torn off the sternum bone (breastbone, extremely rare).

All these ruptures can be partially or fully. mostly the ruptures at the humeral insertion are fully torn and type 2 and 3 ruptures are offen partial ruptures.

 

How does a pectoralis major muscle rupture occur?
These injuries generally occur during forceful activities. Almost half of all pectoralis major ruptures occur during weightlifting, particularly during a bench press maneuver. Other causes of a pectoralis major rupture include football,  rugby, wrestling and other traumatic accidents/injuries.

It is known that steroid use can weaken the tendon, and this is thought to be a contributing factor in many pectoralis major muscle ruptures. However, these injuries can certainly occur in patients who have never used steroids.
 

What are the symptoms of a pectoralis major muscle rupture?
Patients who experience a pectoralis major rupture feel sudden pain, and often a tearing sensation in their chest.

Symptoms include:

  • Pain in the chest and upper arm.

  • At time of rupture a "tearing" sound can be "heard", you can compare it to the sound of a towel that is torn. This sound is mostly heard when a part of the muscle itself ruptures, sometimes a tendon from the bone rupture gives more of a "popping sound". And sometimes hardly nothing can be "heard".

  • Weakness in pushing the arms out in front of the body

  • Bruising in the chest and arm. This bruising can spread as time passes (days).

  • A dimpling, or pocket, formed just above the arm pit where the rupture occurred .

  • Shoulder pain can occur with chronic tears as the shoulder will compensate for the pectoralis major not having it's full range of motion/strength.

 

What is the treatment of a pectoralis major muscle rupture?
Type 1 ruptures: Surgery is most often recommended for complete tears of the pectoralis muscle tendon. By repairing the torn tendon to the bone, patients have a good chance at returning to high-level sports and activities. Ideally the repair is performed in the early period following the injury. By performing the repair within several weeks of the injury, scar tissue and muscle atrophy are minimized. The repair is performed by placing large sutures in the torn tendon, and then securing these sutures to the arm bone with either holes in the bone or anchors inserted in the bone. Type 1 ruptures can be repaired with a high success rate many years after the date of the injury! However a chronic (> approx. 3 months) type 1 rupture can have a retracted muscle/tendon. If retracted lateral to nipple line usually a qualified surgeon can still do a direct repair; if retracted medial to nipple line then the repair needs a tendon allograft reconstruction. This means that the surgeon will use a tendon from your own body(hamstring) or from a donor cadaver (Achilles from a dead person).

Type 2 ruptures: Some surgeons prefer to operate ASAP and others prefer to wait for consolidation of the scar tissue and then reef the muscle-tendon junction with a special high strength suture material that encourages healing.
(you cannot repair muscle directly, therefore it is said that it is better if the surgeon waits for some fibrous tissue at either side of the tear). A very chronic tear can be very difficult to repair. One surgeon told this website that it can be done and he says that he uses a suturing technique the same as with a hernia repair. 

Type 3 ruptures: extremely rare and almost impossible to repair, but
one surgeon told us it can be tried by reinforcing it with an achilles tendon allograft. Most surgeons do not advise to operate these kind of injuries.

Type 4 ruptures: extremely rare and not possible to repair.
Their is only muscle and no tendon at the sternum. Also an operation would leave a big and striking scar in your breast area.

 It is evident that it is highly likely that all patients will benefit greatly from a repair on all chronic and acute type 1 ruptures. Patients who have partial tears, especially type 2 or type 3 tears, or elderly and low-demand patients, might not benefit from an operation. This is a point of discussion if operation will be useful or not. Some surgeons recommend surgery for most type 2 ruptures even after after a delayed time. Most surgeons do not advise to operate on type 3 ruptures; partial tears of the muscle belly are usually not recommended for surgery especially not if the injury date is more then a year ago. The reason why type 2 and 3 tears are often not recommended for surgery is that the recovery can be very fragile. To suture muscle to muscle or muscle to tendon is like suturing two pieces of beef together. Therefore recovery will be very prone to re-tearing because when the muscle is (accidently) flexed/tensed then the sutures will pop very easily. With type 2 and 3 ruptures the suture technique and suture used by the surgeon are extremely important. The mean load and strain that the sutured muscle can endure can differ by suture technique. This study for example has shown that the better method of repair for suturing muscle is the use of combination stitches. It will be out of the scope of this site to study all suture techniques, so please ask your surgeon to study this. One surgeon recommends using Orthocord sutures above other sutures: different types of sutures.

For type 2 and type 3 tears there are alternate experimental options which are not scientifically proven to work.
- Option 1. If there is some muscle left on the tendon or in that area, you can locally try to enlarge/strengthen that muscle with IGF1-L3. This will take a lot of time and it is not sure that it will work fully. However, it will give improvement.

- Option 2: there is a clinic in Panama, which experiments with stem cells extracted from fat cells. Together with other fat cells they will try to restore the dent and make it visual better looking. This will be very fast results, but it is unsure if this works. Link: http://www.cellmedicine.com/description.asp

This website does not recommend these alternative options!
 

How can I prevent pectoralis major injury?
Weight lifters should be instructed on proper bench press technique. The most important considerations are to limit the distance the bar is lowered, and to narrow the grip of the hands to the bar. Lowering the bar all the way to the chest, or widening the grip on the bar, increases the stress on the muscle and increases the chance of a pectoralis injury.

References: