Pectoralis major tendon injury

The pectoralis major is a powerful pectoral muscle that causes the arm to rotate inward and in toward the body. It can also help move your arm forward or backward. The muscle originates from two points: the sternum (breastbone) and the clavicle (clavicle). These two sections of muscle join at the pectoralis major tendon, which attaches to the humerus bone of the upper arm, near the biceps tendon.

Pectoralis major tendon injury is relatively uncommon, but it can cause significant disability in athletes.

How do pectoralis major injuries occur?

The pectoralis major tendon is most often injured during an eccentric contraction, when the external force on the muscle is greater than the force the muscle can generate, and when the arm is extended and externally rotated (outward), such as when performing a bank. press.

The bench press is the most common cause of injury, but other injury-inducing activities include rugby union, skiing, soccer, wrestling, hockey, and skydiving. Major pectoral injuries generally occur in men between the ages of 20 and 40 and have affected several New York Giants football players. The injury can cause pain in the chest and upper arm, weakness, and deformity of the chest and upper arm.

How do doctors diagnose pectoralis major injuries?

This injury can often be identified through a physical examination, as the muscle mass and shape of the chest wall are visibly different on the injured side compared to the normal side. Chest wall bruising may also be evident. These physical findings are often accompanied by pain when attempting to internally rotate and pull the arm to the side. If the injury is chronic, doctors may notice a decrease in muscle mass.

X-rays are rarely helpful in making the diagnosis, but MRI and ultrasound are very effective in helping sports medicine experts confirm this injury.

What are the treatment and rehabilitation options?

Surgery is usually necessary to repair pectoralis major injuries, except when there is a partial tear of the tendon, when there is a tear in the center of the muscle, or in elderly patients. Athletes who injure their pectoralis major muscle often want to regain strength to return to their sport. This is best accomplished with surgical repair. One study has shown that only 27 percent of athletes treated without surgery had an excellent result.

Surgical treatment involves an incision centered between the pectoralis major muscle and the deltoid muscles of the shoulder. The tendon can be reattached to the bone using a variety of techniques. Occasionally a tendon transplant is required to complete the repair, usually when the injury is chronic.

After surgery, patients are usually immobilized in a sling for three to six weeks. Gentle pendulum exercises are started during this period. Carefully instructed passive and active exercises are added over the next few months, and light weight lifting is allowed at four months. Patients usually return to competitive activity after six months.
 

Key points to remember

Pectoralis major tendon injury is relatively uncommon, but it can cause significant disability in athletes.

• The bench press is the most common cause of injury.
• Surgery is usually required to repair the injury, giving athletes a better chance of returning to play.
• Athletes can usually return to competition six months after surgery.