Managing Pectoralis Major Tears: Diagnosis and Treatment Introduction Tears of the pectoralis major can occur with weight lifting and may require surgery for full thickness tears.
Managing Pectoralis Major Tears: Diagnosis and Treatment Tears of the pectoralis major can occur with weight lifting and may require surgery for full thickness tears. The pectoralis major (PM) muscle originates from the clavicle and sternocostal joint and inserts 4cm distal to the greater tuberosity on the lateral portion of the humerus. The action of the PM includes adduction, internal rotation, and forward elevation.
Injury tends to occur in athletes in their 20s-40s and is typically associated with bench press. Wrestling, gymnastics, and football are the sports that see the highest number of PM tears. In football, the act of blocking with the arm abducted and externally rotated puts the PM at risk for injury with a sudden eccentric contraction.
Anatomy of pectoralis major Diagnosis The typical history of a PM rupture is a sudden sharp pain in the shoulder sometimes associated with a snap. Physical examination findings consistent with an insertional tear are pain to palpation at the insertion on the humeral head and within the patient’s axilla. Providers should also evaluate for a sulcus sign at the dectopectoral groove.
The patient's shoulder is placed in 90 degrees of abduction and external rotation, which allows for assessment of the pectoralis major tendon within the dectopectoral groove. Patients can also be found to have swelling and ecchymosis over the anterior chest and axilla. Plain radiographs are typically unremarkable.
Physical examination finding for pectoralis major tear (tear demonstrated on the patient’s left side) MRI and ultrasound can both aid in diagnosis of a muscle belly tear verse an insertional tendon tear. Ultrasound findings of an acute tear are hypoechoic hematoma formation and visualization of potential space, suggesting tendon retraction. For best visualization of the PM, MRI orders should focus on chest wall sequences and not shoulder sequences.
If you are experiencing symptoms that may be related to pectoralis major tears, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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