INTRODUCTION​

• Pectoralis major ruptures are injuries to the main chest muscle

• They are rare injuries that often occur in weightlifters 

• The vast majority of cases occur in males with few, if any, cases in females

CAUSES

Almost always occur in weightlifters where there is excessive tension on the pectoralis major tendon when the patient is lifting weights and contracting their chest muscles eccentrically

SIGNS AND SYMPTOMS

• Feeling a pop and pain in the front of the shoulder/chest with weightlifting activity

• Diffuse, deep anterior chest pain and weakness

• Often characterized by deep bruising in the chest and arm

• “Dropped nipple sign” where the injured side’s nipple is lower than the uninjured side

• Loss of axillary crease on the injured side

TREATMENT​​

• Sling wear, rest, ice, anti-inflammatories followed by a course of physical therapy can be recommended in elderly, sedentary patients with tendinous avulsions or in patients with low-grade partial tears or muscle belly tears

• Most young, active patients with acute pectoralis major muscle tears require surgery to regain strength and return to sport/activity. 

• Surgery is done with an open technique where incision is made over the ruptured tendon insertion and tendon is repaired directly down to bone using suture anchors, buttons, or direct repair to bone trough

PREVENTION​

• Avoiding heavy weightlifting, especially with eccentric muscle contractions may reduce likelihood of a pectoralis major rupture