What is Pectoralis Major Tear?
Damages to the pectoralis major muscle, the big muscle in the chest, don’t happen often. Most of these injuries occur when lifting weights, particularly during a bench press workout, but they can also happen in several other sports. There are various factors, like delays in seeking care or recognizing the injury, that can postpone the right treatment and potentially lead to worse results for the patient. The specific treatment for this type of injury depends on how severe the injury is, how active the patient is, and what their day-to-day living needs are.
What Causes Pectoralis Major Tear?
A pectoralis major lesion is a type of injury that happens when the pectoralis major muscle, found in your chest, tears due to extreme strain. This often happens when the muscle is stretched to its limit while also being contracted, or tightened. Sometimes, it can also occur due to a direct hit or trauma to the muscle.
Risk Factors and Frequency for Pectoralis Major Tear
Pectoral muscle injuries typically happen most often in young, active men in their thirties and forties. These injuries are frequently linked to weight lifting, especially the bench press. However, they have also been reported in other activities like martial arts, gymnastics, and football. There’s also a connection with the use of anabolic steroids.
- Pectoral muscle injuries mostly occur in men in their thirties and forties who are physically active.
- Weight lifting, particularly bench pressing, is often associated with these injuries.
- These injuries can also occur during other activities like martial arts, gymnastics, and football.
- There’s a connection between these injuries and the use of anabolic steroids.
Signs and Symptoms of Pectoralis Major Tear
When a patient visits a doctor after being injured, they often remember and can explain exactly how the injury happened. Most of the time, the patient will describe feeling a tear or a sudden “pop”, followed by intense pain and swelling in a specific area, bruising, and a noticeable difference in how things look. Sometimes, patients might overlook these injuries, assuming they’re just minor strains or sprains, and only seek medical help when the symptoms persist.
During a physical examination, the doctor might notice swelling and bruising on the patient’s chest, underarm, and arm. There can also be a visible bulge on the inner side of the muscle, or a thin, web-like appearance of the front underarm. Touching the injured area might cause pain, especially along the underarm fold, which might look thinner, indented, or even completely absent. The doctor might ask the patient to lift their arm 90 degrees to make these symptoms more noticeable. The patient might also experience pain, along with restricted movement and weakness when rotating the arm inwards or moving it close to their body.
Testing for Pectoralis Major Tear
When a rupture or tear happens in the main chest muscle, pectoralis major, doctors use certain techniques to identify it. Standard X-rays aren’t typically very helpful for spotting a tear in this muscle, but they can assist doctors in looking for other related issues. For example, doctors can find injuries where a small piece of bone gets pulled away, which happens in 2% to 5% of these cases.
Ultrasound can also be used to identify a tear in the pectoralis major muscle. It’s relatively cheap and quick, which can make a significant difference in care. The ultrasound can usually spot the tear by looking at the muscle’s unevenness and tearing compared to the other side of the chest. However, there are some concerns about using ultrasound for this purpose because it might miss some injuries and give a false-negative result.
The best way to spot a chest tear like this is by using Magnetic Resonance Imaging (MRI). This tool gives a very accurate picture of what’s happening in the chest, allowing doctors to tell if the tear is new or old, complete or partial. It can also help determine the extent and location of the injury, which can usually be confirmed later during surgery.
To better understand the injury, doctors often use a classification system created by Tietjen in 1980. Type I injuries include muscle bruises and tears, type II is for partial tears, and type III includes complete tears. Type III injuries are then split into further categories based on the location of the injury: sternoclavicular origin (close to the center of the chest), the main body of the muscle, the junction between the muscle and tendon, and the point at which the muscle attaches to the bone.
Treatment Options for Pectoralis Major Tear
If you tear your pectoralis major, which is a large muscle in your chest, the treatment you receive will depend on how serious the injury is and how much you use the muscle. For example, a treatment plan could differ depending on whether you’re a professional athlete who uses these muscles heavily, or a more sedentary person using these muscles for daily tasks. Usually, if the tear is complete, a surgical treatment is the chosen method.
If doctors decide not to do surgery right away, the initial treatment involves resting the injured area, using ice, pain relievers, and immobilizing the affected arm with a sling. The doctors will position your arm close to your body and turn it inward. They recommend that you start gently moving your arm (passive and active range of motion exercises) within the first couple of weeks after injury. Over the next six weeks, you should gradually increase your exercises until you achieve full range of motion.
Once you’ve made it to six to eight weeks post-injury, you can start doing exercises that gradually increase in resistance or difficulty. You can usually start full resistance training around three to four months after the injury.
What else can Pectoralis Major Tear be?
When diagnosing shoulder problems, doctors consider a number of conditions that can cause similar symptoms. These include:
- Biceps tendon rupture
- Shoulder dislocation
- Break in the upper arm bone (proximal humerus fracture)
- Tears in the group of muscles and tendons surrounding the shoulder joint (rotator cuff tendon tear)
- Tear in the muscle under the shoulder blade (subscapularis muscle tear)
- Trapped nerve near the chest (medial pectoral nerve entrapment)
What to expect with Pectoralis Major Tear
The outlook for people with pectoralis major (a large muscle in the chest) tears is usually positive, particularly if the condition is identified quickly and treated correctly. Several studies have examined both surgical and non-surgical treatment options and found that surgical treatment tends to yield better results in terms of overall comfort and physical performance.
Possible Complications When Diagnosed with Pectoralis Major Tear
If someone chooses not to have surgery, there might be several complications, such as:
- Continued weakness
- Changes in appearance due to deformity
- Blood pooling under the skin (Hematoma)
- Creation of pockets of pus (Abscess formation)
- Abnormal bone growth in a muscle (Myositis ossificans)
On the other hand, even with surgery, there might be complications, such as:
- Infection
- Thick, wide, or raised scars (Hypertrophic scar)
- Lack of flexibility (Stiffness)
- The issue might happen again (Re-rupture)
Preventing Pectoralis Major Tear
Patients should know that if they don’t undergo surgery, they may experience a decrease in strength and less successful results with their treatment. In addition, the visual appearance may not be as good if this medical condition is not treated with surgery.
