Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Rupture of the Major Pectoral Muscle

The pectoral muscle has its origin on the anterior chest wall and its insertion on the anterior surface of the upper part of the humerus. Its function is to draw the upper arm towards the chest and to rotate the arm inwards. When it is subjected to a heavy load, the pectoral muscle can tear. A complete tear can be induced by strength training (especially bench-press training), heavy weightlifting, and other strength sports such as wrestling, shot-putting, and discus and javelin throwing. It is usually the tendon close to the insertion of the muscle onto the humerus that is damaged.

Symptoms and diagnosis

– Pain occurs at the insertion of the major pectoral muscle onto the humerus.
– Swelling and bruising (secondary to bleeding) appear over the anterior aspect of the upper arm.
– Tenderness is found over the anterior aspect of the upper arm.
– Impaired strength is noted when the upper arm is adducted (drawn inwards towards the chest) or is internally rotated against resistance.
– The major pectoral muscle fails to contract when the upper arm is pressed inwards against resistance. This can be felt by placing a hand over the muscle so that it covers both the damaged and healthy portions.
– There is visible deformity or loss of definition of the muscle.

Treatment

The athlete should:
– apply acute treatment;
– carry out a gradually increasing strength training program when the tear is partial;
– consult a doctor.

The doctor may operate in cases of complete muscle rupture, especially in weightlifters, since this muscle has no agonist (muscle with same function).

Healing

Following surgery, early range-of-motion exercises are recommended. A supportive sling should be worn for about 2–4 weeks. Strength training should not be resumed until at least 4–6 weeks after the injury and then only with gradually increasing light loads. Increasing the number of repetitions is preferable to increasing the loads.

Return to sport

In a partial tear, early strength training is initiated and sport is resumed when normal strength and pain-free normal range of movement are achieved. After a complete tear, return to sport is possible after 3–5 months. Overuse injury at the insertion of the pectoral muscle The insertion of the major pectoral muscle can be the site of local traction injury with inflammation. The injury occurs particularly in gymnasts, tennis players, badminton players, squash players, golfers, rowers, weightlifters, swimmers, and throwers. The usual cause is intensive strength training and overuse.

Symptoms and diagnosis

– Pain occurs in the region of the insertion of the major pectoral muscle tendon onto the humerus.
– Tenderness is observed at the tendon attachment.
– Pain, and sometimes weakness, are felt when the upper arm is adducted against resistance.

Treatment

The athlete should:
– rest the damaged area;
– apply local heat and use a heat retainer before activity and ice after activity.

The doctor may:
– prescribe anti-inflammatory medication;
– initiate strength and flexibility training;
– give a local steroid injection and prescribe a few days of rest.

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