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 3 types of pectoralis ruptures:
type 1: rupture at humeral insertion (tendon ruptured from the bone)
type 2: rupture of musculotendinous junction (rupture in between tendon
and muscle),
type 3: rupture of muscle belly (rupture in the muscle itself).
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 mostly 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:
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Pain in the chest and upper arm.
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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".
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Weakness in pushing the arms out in front of the body
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Bruising in the chest and arm. This bruising can spread as time passes (days).
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A dimpling, or pocket, formed just above the arm pit where the rupture occurred .
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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?
Surgery is most often recommended for complete tears of the pectoralis
muscle tendon(rupture type 1). 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!
Patients who have partial tears, especially type 2 or type 3 tears, or elderly and low-demand patients, sometimes can not be operated. 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 used by the surgeon is 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.
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
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 pectoralis injury.
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