What are pectoralis major ruptures?The pectoralis major muscles, or pecs, are the large muscles that sit on the front of the chest wall and attach to the upper arm. The muscles provide power to the shoulder; they rotate the shoulder and pull the arm towards the body. The pecs are necessary for activities of daily living and provide strength, and are important in athletes, particularly throwing athletes.
Injuries to the pecs are relatively rare but there has been an increase in tendon tears, often seen in weightlifters, but also in contact sportsmen. Injuries are almost exclusively seen in men.
Injuries occur with powerful eccentric contraction (lengthening) of the muscle, such as in weightlifting or vigorous sporting collisions. Most tears of the tendon occur at the bone-tendon junction, where the tendon attaches to the upper arm, though musculo-tendinous junction and intra-muscular tears are also seen.
Pec Major MRI
What are the signs and symptoms?Patients tend to report a history of either significant injury during sports or weightlifting with sudden tearing pain, and sensation, at the front of the shoulder. Patients experience characteristic bruising in the armpit and anterior chest wall and there is asymmetry in the pecs and levels of the nipples, with the injured side drooping and losing shape.
How is a pectoralis major rupture diagnosed?If a tear is suspected clinically, an MRI scan will confirm if the tear is from the arm bone or at the junction between the muscle and the tendon. This is important in the decision making for surgical repair of the tear and an MRI will be arranged if there is clinical concern that a tear has occurred.
Pec Major Repair Post-op
How is it treated?In older, less active, individuals tears can be treated without surgical intervention; with time and painkillers, the pain will subside. Swelling after a tear can last up to three weeks and bruising as long as six weeks. As pain settles, normal activities can be resumed, with some loss of strength of the torn muscle.
In younger, active and sports people, surgical repair can be performed to restore the anatomy and the function of the pectoralis muscle, if the tear has occurred at the tendon-bone junction. Ideally, surgery should be performed in the early stages after injury (weeks) but late repair can be performed with good results.
Surgery for pec major repair is performed as a day-case procedure under general anaesthetic. An incision is placed at the top of the arm, above the armpit fold. The tendon tear is identified and large stitches are placed in the tendon to re-attach it to the humerus with either suture anchors or cortical buttons (Figure). After surgery a sling offers protection while the tendon starts to heal, but physiotherapy is needed to maintain range of movement of the shoulder joint. The results of surgery are good with a return of 98% strength of the muscle.
What are the potential complications?Complications are uncommon following surgical repair. There is a small risk of infection with the incision being near to the armpit, and a small risk of re-rupture (a few per cent only).
What rehabilitation is necessary after surgery?Following a pec major repair you will be in a sling for three to six weeks. Physiotherapy will commence within a week of surgery and you will be allowed to move your shoulder in a protected way soon after repair. Driving can resume four to six weeks after surgery, when safe to do so.
A big thank you to Simon and his team for their care, patience and perseverence looking after me through all stages of both shoulder and elbow surgery.
Since the shoulder stabilisation I have continued my sailing and fitness training without the worry that my shoulder might dislocate; and I don’t have to think twice whether my ulnar nerve will hinder any progression in my sports.
With their amazing help, I’ve been able to get back to sailing competatively and am now a double National champion.
After multiple shoulder dislocations Charlie helped me set a route for recovery, which has been nothing but smooth sailing. Surgery went successfully and I am well on my way to playing the sports I was previously. Would highly recommend.
Simon successfully operated on my frozen left shoulder in 2012 with fantastic results. This year he has overseen and advised treatment for my frozen right shoulder (via hydrodilation injection). His unrivalled experience in orthopaedic shoulder treatments, coupled with his reassuring bedside manner and excellent results, gave me huge confidence throughout. I’m hugely grateful to have my quality of life back and wouldn’t hesitate to recommend his services. Thank you Simon.
I had suffered with a painful shoulder and pins and needles for three years following a right shoulder fracture and failed half joint replacement prior to meeting Mr Pennington. He explained the situation in a way I could relate to and I’m delighted to say my revision shoulder replacement has gone well and for the first time in years I can use my arm and am pain free. I was even able to walk my daughter down the aisle 3 months after surgery! Many thanks.
I would like to thank Charlie Talbot and his team for the operations performed on both my shoulders and also the aftercare put in place after my operations. I have played golf since I was 12 years of age and thought at one point that I would never get back to playing again. Charlie was always very positive and told me that he would get me playing golf again. Well, I have now been playing golf for nearly 2 years. Before surgery I had a handicap of 12 and I am now down to 9, not bad at the age of 68. So many many thanks.
I had PRP injections into my right elbow last year and within 3 months I was pain free, a year on it is more or less 100% better. Fabulous I would recommend it to anyone with Tennis Elbow, in fact I have gone back again this year to get my left elbow done. Thanks Simon.
Mr Pennington I really wanted you to know how very thankful I am for the excellent care & treatment you and your staff gave me. It really meant a lot that you were so clear, friendly & professional and listened to me – so thank you again.
After more than four decades of shoulder problems with a total of three surgeries the full shoulder replacement surgery by Mr. Talbot has changed my life beyond expectations. I am now able bodied for the first time in years and pain free.
Thank you to Mr Boyle and team for the excellent care and attention both before and after Replacement Shoulder surgery, using the Tornier Simpliciti procedure. After very many months of severe pain and lack of movement I was pain free from day one. Now, after nine weeks, the shoulder and arm movement continues to improve, beyond expectation, with physiotherapy and exercise. I am extremely grateful for all the continuing care.
Following two years of recurrent problems with my left shoulder I was recommendedto Consult Mr Neil Pennington. I had the opportunity to have my surgery quickly and at my convenience, this fitted well around my professional and home commitments. The surgery was carried out as a day case procedure and Mr Pennington visited me following the surgery to explain everything. My operation was a minimally invasive procedure so my recovery was straightforward with only a few restrictions; in fact I was encouraged to keep my shoulder moving. I was driving and back to work after 2 weeks – after 2 years of pain and sleep disturbance I found this operation to be life changing! I found Mr Pennington to be a very professional and compassionate surgeon and he is surrounded by a whole team of professionals that gave me the utmost confidence in the care and treatment I received.
I would like to thank Mr. Talbot and the amazing team of nurses, physiotherapists and support staff for their care and support during my recent visit to the Duchy Hospital, Harrogate, for a replacement shoulder. The care and attention I received was unparalleled. The pain free movement I now have has changed my life.