Pectoralis Major Muscle Rupture

The pectoralis major muscle, or most commonly its tendon that attaches to the arm bone, can rupture. Athletes often call this a pec rupture or torn pec, but it is more accurately called a pectoralis major muscle rupture. Pectoralis major ruptures are uncommon 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.

The pectoralis major muscle is the large muscle just 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 maneuver.

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 (blocking), wrestling, rugby, and other traumatic 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.

Patients who experience a pectoralis major rupture feel a sudden pain, and often a tearing sensation in their chest. Symptoms include:

• Pain in the chest and upper arm
• Weakness in pushing the arms out in front of the body
• Bruising in the chest and arm
• A dimpling, or pocket, formed just above the armpit where the rupture occurred

Surgery is most often recommended for complete tears of the pectoralis muscle tendon. Patients who have partial tears, tears within the muscle, or elderly and low-demand patients, may be able to avoid surgical treatment.

By repairing the torn tendon, patients have a good chance of 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.

Yes, some authors have shown good results with repair months, or even years, following the injury. Again the repair is best done in a timely fashion, but there are studies that show patients who have late repairs can find improved cosmesis (appearance of the chest), strength, and overall satisfaction.

Weightlifters 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 on 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.