Pectoralis Muscle Tear: Not All Need Surgery
Multiple pectoralis injuries this week in the NFL. Here is a look at the injury and the reason why all pectoralis injuries don't necessarily need surgery. In football, this most commonly occurs when the muscles are engaged (blocking) and the arm is forced out an away from the body. Take a look at the anatomy below where the pectoralis major muscle actually inserts on the shaft of the upper arm bone. 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. However, It can be difficult to regain full strength compared to pre-injury levels.
Anatomy of the Injury
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 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. In everyday life, the most common cause of a tear is while performing a bench press. We typically hear of reports of this type of injury occurring during or training for the bench press portion of the NFL Combine.
Keep in mind there are two pectoralis muscles (major and minor), and not all injuries occur to the pectoralis major. The pectoralis minor is much smaller and does not attach to the arm, which limits its exposure to injury.
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.
When is Surgery Required?
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 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 to Play
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. 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.