What is a pectoralis major tear?
The pectoralis major is the large muscle of the chest. It fans out from the breastbone and collarbone, then narrows to a flat tendon that attaches to the upper arm bone. It pulls the arm across the body and powers pressing and pushing.
A tear can happen in the muscle itself, where the muscle meets the tendon, or at the tendon’s attachment to bone. Most tears that need surgery are the tendon pulling off the bone, usually the lower part, called the sternal head. This injury can be partial or complete.
How does it happen?
The classic injury is the bench press. As the bar comes down, the muscle is working hard while it is being stretched, and the tendon gives way. It can also happen while tackling, wrestling, doing dips, or grabbing something heavy as it falls.
In a review of 23 studies and 664 injuries, 63.2% happened during weight training. All the patients were men, and the mean age was about 31 (Bodendorfer, 2020). Women can have this injury too, but it appears to be uncommon.
What does it feel like?
Most people describe a sudden pop or tearing feeling in the chest or the front of the shoulder, followed by pain and weakness. Over the next days you may see:
- Bruising across the chest and down the upper arm
- A change in the fold of skin at the front of the armpit
- A chest that looks different from the other side, especially when you press your hands together
- Weakness with pressing or pulling the arm across the body
Swelling can hide the signs early on, so a tear can be missed, and a torn tendon may be mistaken for a bad strain.
Why does timely evaluation matter?
A strain and a complete tendon tear can feel alike in the first few days, and they have very different plans. Your surgeon will examine the chest and arm and will often order an MRI, which shows where the tear is and how much tendon is involved.
Timing matters because a torn tendon pulls back and scars over the following weeks. A second review of 20 studies and 384 injuries, by the same research group, found that earlier repair gave better function and more satisfaction with appearance than later repair (Bodendorfer, 2020).
The evidence is not all one way. Another review looked at 259 repairs and found no statistical difference between acute repairs and those done more than 8 weeks after injury. Its authors said the quality of the evidence was low (Gupton, 2019).
A sensible reading is that early evaluation keeps your options open. If your injury is already months old, surgery may still be possible, though a tendon graft is sometimes needed.
Do I need surgery?
Not always. Tears in the muscle itself, partial tears, and tears in people with lower demands are often treated without surgery. This usually means rest, then physical therapy.
For complete tendon tears in active people, repair is usually discussed. In the review of 664 injuries, surgery was significantly better than non-surgical treatment for function, strength, appearance, and the shape of the chest at rest (Bodendorfer, 2020). You should know that comparative data are limited for this uncommon injury.
What does repair involve?
Surgery is done through an incision near the front of the armpit. The surgeon finds the torn tendon, frees it from scar tissue, and attaches it back to the upper arm bone. This can be done with bone tunnels, suture anchors, or small buttons.
The fixation method does not appear to change results much. One review found no significant differences among fixation methods (Bodendorfer, 2020). Another found some differences, but its authors called all three main techniques accepted options (Gupton, 2019).
Can I go back to lifting after repair?
A review of 18 studies and 536 patients found that 90% of those tracked returned to sport at a mean of 6.1 months, and 74% returned to their earlier level. Return to work was 95%, at a mean of 6.9 months (Yu, 2019). Those are group averages, not a promise for any one shoulder.
What are the risks of surgery?
Risks include infection, wound problems, rerupture, stiffness, ongoing weakness, and nerve irritation. Reviews put the overall complication rate at 14.21% to 18%, with a rerupture rate of 3.08% in one of them. About 7% needed another operation (Bodendorfer, 2020; Yu, 2019). No surgeon can promise a certain outcome.
Should I get a second opinion?
It can help, especially if you were told your injury is only a strain and your chest looks different, or if you were told it is too late to repair. Here’s how a second opinion works.
Where can I see Dr. Pareek?
Dr. Pareek sees patients with chest and shoulder injuries at HSS in New York and at HSS in New Jersey. Bring any X-rays, MRI images, and reports you already have.
What does recovery look like?
These are typical ranges. Your surgeon’s plan comes first, and recovery varies from person to person.
- Weeks 0-2: Protect the repairMost people wear a sling and keep the arm at the side. The focus is on pain, wound care, and moving the hand, wrist, and elbow.
- Weeks 2-6: Start gentle motionPhysical therapy begins careful shoulder motion. Reaching out to the side and behind the body is usually limited while the tendon heals.
- Weeks 6-12: Regain motionThe sling usually comes off, and therapy works toward full motion with light strength work added as allowed.
- Months 3-6: Build strengthResistance work builds step by step. Heavy pressing and chest flies wait until your plan clears them.
- Months 6 and beyond: Return to lifting and sportMany people return to sport and heavier lifting around this time. These are typical ranges, and your surgeon's plan governs.
Sources
- Bodendorfer BM, et al. Treatment of pectoralis major tendon tears: a systematic review and meta-analysis of operative and nonoperative treatment. Orthop J Sports Med 2020;8:2325967119900813.
- Bodendorfer BM, et al. Treatment of pectoralis major tendon tears: a systematic review and meta-analysis of repair timing and fixation methods. Am J Sports Med 2020;48:3376-3385.
- Gupton M, et al. Surgical treatment of pectoralis major muscle ruptures: a systematic review and meta-analysis. Orthop J Sports Med 2019;7:2325967118824551.
- Yu J, et al. Outcomes and return to sport after pectoralis major tendon repair: a systematic review. Sports Health 2019;11:134-141.