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Pectoralis Muscle, Tendon Tear

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The pectoralis major is a large muscle that lies in front of the chest wall (Figure 1). It is a powerful adductor, internal rotator, and flexor of the shoulder.

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The pectoralis major has two heads; the clavicular head (upper part) and the sternal head (lower part) (Figure 2).

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The pectoralis major muscle works to push the arm in front of the body. Ruptures of the pectoralis major muscle are due to weight training, particularly during a bench press maneuver (Figure 3). Ruptures or tears of the muscle are uncommon.

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The patient will experience pain while extending the arm. Ecchymosis is present down the arm. The pain is worsened with resisted adduction and extension. There will also be a loss of normal contour of the axillary fold (Figure 4).

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The rupture usually occurs in males 20-50 years old, weight lifters (especially those practicing bench press), football players and wrestlers. The rupture can occur in the absence of taking steroids. It usually occurs as a complete tear from the bony insertion of the humerus.

How do you prevent a rupture?
To prevent a rupture one must practice the proper bench press technique, limit the distance the bar is lowered, and narrow the grip of the hands on the bar.

Treatment
For a complete tear of the pectoralis major muscle, it must be repaired early. A delayed or chronic rupture, which usually occurs longer than a few months, will probably require a tendon graft. The muscle is retracted and the operation is difficult. The result is not as good as in an acute repair.

Acute Repair
The tendon is sutured and attached to the humerus with anchors (Figure 5). The sutures are tightened to approximate the tendon to the bone.

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