Randon Hall, MD
Pectoralis Muscle Tear
Photo by Jesper Aggergaard on Unsplash
Injury: Pectoralis Muscle Tear
Mechanism: The pectoralis major is a broad muscle that includes two major sections. The sternal portion runs from the sternum (breast bone) across to the upper arm, and the clavicular portion runs from the clavicle to the upper arm as well. An injury can occur with excessive stress to the muscle, either causing a tear within the muscle belly, muscle-tendon junction or bony attachment site. The most common cause of a tear is while performing a bench press. The clavicular portion tends to be torn more often at the insertion site into the upper arm (humerus) as that is the site under the most stress during this exercise.
Evaluation: At the immediate time of injury, the athlete may have sharp pain over the upper chest. There may also be significant bruising. The diagnosis is usually made on clinical exam with strength testing of the muscle, as well as inspection for asymmetry or deformity. In most cases, an MRI will be obtained to confirm the diagnosis and to determine the extent of the injury. Recently, ultrasound has been used as well as it can be done on the sideline or in the locker room.
Treatment: In general, if the tear is in the muscle belly and considered a partial tear, a non-operative approach would be taken. If there is a complete tear of the muscle or an injury at the muscle-tendon junction or bony attachment site, surgery is usually recommended. However, one might take a different approach to the same injury in a 21 year old athlete compared to a 40 year old man. Non-operative treatment includes sling immobilization and gradual progression of range of motion over the first 6 weeks. With either operative or non-operative treatment of a significant tear, the athlete is going to need about 3 to 4 months to return back to full resistance training and likely 6 months to return to full contact sports.
Return: For the most part, it is felt that young athletes have better outcomes and better overall satisfaction with surgical repair when the situation is appropriate. As mentioned above, an athlete is going to need about 3 to 4 months to return back to full resistance training and likely 6 months to return to full contact sports.
Sports Considerations: Even with surgical intervention one should consider that recovery from a pectoralis injury is not easy. It can be difficult to regain full strength compared to pre-injury levels.
Athletes: Billy Price