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Pectoralis Major Muscle Injuries: Evaluation and Management

Dr. Petilon is Lieutenant, Medical Corps, United States Navy, and Flight Surgeon, Naval Medical Center Portsmouth, Portsmouth, VA. Dr. Carr is Lieutenant Commander, Medical Corps, United States Navy, Bone and Joint/Sports Medicine Institute, Department of Orthopaedic Surgery, Naval Medical Center Portsmouth. Dr. Sekiya is Lieutenant Commander, Medical Corps, United States Navy, Bone and Joint/Sports Medicine Institute, Department of Orthopaedic Surgery, Naval Medical Center Portsmouth. Dr. Unger is Captain, Medical Corps, United States Navy, and Chairman and Residency Director, Bone and Joint/Sports Medicine Institute, Department of Orthopaedic Surgery, Naval Medical Center Portsmouth.

Reprint requests: Dr. Sekiya, Naval Medical Center Portsmouth, 27 Effingham Street, Portsmouth, VA 23708.

Pectoralis major muscle tears are relatively rare injuries that primarily occur while lifting weights, particularly when doing a bench press. Complete ruptures are most commonly avulsions at or near the humeral insertion. Ruptures at the musculo-tendinous junction and intramuscular tears usually are caused by a direct blow. The patient may hear a snap at the time of injury and report pain, weakness, swelling, or muscular deformity. Physical examination can reveal ecchymosis, a palpable defect, asymmetric webbing of the axillary fold, and weakness on resisted shoulder adduction and internal rotation. A detailed history and physical examination can be augmented by radiologic studies, including magnetic resonance imaging. Non-surgical treatment is now recommended only for the older, sedentary patient or for proximal muscle belly tears. Surgery, whether early or delayed, consistently yields superior results compared with nonsurgical management. Prompt diagnosis and timely intervention likely will produce improved results.

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