About Pectoralis Major Repair
Located at the front of the chest, the pectoralis major is a large and powerful muscle that allows for several arm movements. These include: rotating the arm inwards, pulling the arm across the body, pulling the arm down from above the head, and pulling the arm upwards from the side. The pec attaches to the upper arm of the bone (the humerus) and is divided into 2 parts: the clavicular head and the sternal head. If there’s any type of injury such as a rupture or strain, these arm movements can be severely limited. There are a variety of treatment options depending on if it’s a partial or complete rupture. When the injury isn’t as severe, nonsurgical methods, such as physical therapy can be used. However, when a complete rupture is present, surgery is usually the only option.
After a thorough examination, if surgery is warranted, Dallas orthopedic shoulder surgeon, Dr. Brody Flanagin, will recommend the best approach. Using the latest advancements in shoulder surgery, Dr. Flanagin will surgically treat the pectoralis region so that the repair offers an effective recovery. It's important to have an orthopedic surgeon assess this injury as some cases are complex and may require the use of a graft to reconstruct the tendon or ligament.
Types of Pec Ruptures
A pectoralis major rupture can occur in a number of different locations, including
- Type 1: A tendon rupture off the humerus bone, which is the most common type of rupture. This is the point where the pec is the most vulnerable to injury. Surgery is usually recommended for this type of rupture.
- Type 2: A tear can happen at the junction where the muscle and tendon meet. This is known as a musculo-tendinous junction. With Type 2, a surgeon might operate immediately or wait until some healing has begun.
- Type 3: Another scenario is when a tear occurs in the belly of the muscle, which is extremely rare. This type of rupture is extremely difficult to surgically repair.
- Type 4: In rare instances, the muscle actually tears away from the sternum, or the breastbone. Type 4 is also extremely rare and is difficult to surgically repair.
Any of these tears can take place during physical activity, more specifically in weight training. As weight training and power lifting become more common, the incidences of these types of injuries are increasing. Lifters are especially susceptible to tears while bench pressing since the pec is heavily involved during the exercise. Pec tears also happens during wrestling, football, rugby, or due to traumatic injuries or accidents.
"Very professional, listens to questions/concerns, provides logical answers and concise information on medical issue(s), a no nonsense yet personable physician with a dry wit and integrity. He will not rush to surgery unless warranted. And, will not order a bunch of unnecessary tests. I highly recommend Dr Flanagan."- L. / Healthgrades / Oct 19, 2017
"Dr. Flanagin and his staff are amazing! I've only seen him for minor issues but I'm usually in and out in 30-45 minutes, which includes X-ray time. Great staff!"- J.R. / Yelp / Aug 29, 2018
"Dr. Flanagin and his staff are amazing! I've only seen him for minor issues but I'm usually in and out in 30-45 minutes, which includes X-ray time. Great staff!"- J.R. / Yahoo / Aug 28, 2018
"Dr Flanagin is a 10 star! - too bad the scale only goes to 5."- D.S. / Google / May 18, 2018
"Amazing Doc! No-nonsense, straight-forward, knows his stuff, and clearly committed to his patients. Siprina, the x-ray tech, was great as well. Very pleasant and explains "what to do" in a manner even a country boy like me could understand. Thanks to Siprina."- D. / Healthgrades / May 18, 2018
Symptoms of a Pec Tear
These are the most common symptoms of a pec tear:
- A “tearing” or “ripping” sound can be heard when the pec tears. In other cases, it can sound like a “pop.”
- Intense pain is felt in the chest and the upper arm, including the shoulder.
- There’s a weakness when trying to push the arms out in front of the body, which includes muscle weakness through the arms and chest.
- Visible bruising might appear through the chest area and upper arms.
- Dimpling or a pocket might develop directly above the armpit where the injury occurred.
What to Expect
Type 1 ruptures often require surgery when there’s a complete tear and is performed soon after the injury for the best outcome. This type of repair places large sutures (stitches) in the torn tendon to reattach to the arm bone with anchors placed in the bone or holes made in the bone. This type of surgery has a high success rate and most patients can return to sports and physical activities after their recovery. However, if the rupture happened more than 3 months ago, there’s a chance that the tendon and muscle have retracted. If this is the case, a tendon from the hamstring may have to be grafted to repair the damaged tendon.
With a Type 2 injury, some surgeons will operate immediately while others will wait until fibrous tissue has developed on either side of the rupture. This procedure involves connecting the muscle and tendon with extremely durable suture material in order to promote proper healing. When dealing with older injuries, a surgeon may have to utilize other techniques such as those used to repair hernias.
Both Type 3 and Type 4 ruptures are extremely rare, and difficult to operate on. Type 3 might can be treated through an Achilles tendon grafting procedure. However, the majority of surgeons do not recommend surgery for a Type 3 rupture. Since Type 4 involves muscle with no tendon at the injury site, a highly-skilled surgeon would be needed to use advanced techniques to repair this type of injury properly.
All ruptures can be partial or complete and partial tears may not require surgery, especially Types 2 and 3. Conservative surgery or other nonsurgical treatment options may be available, which can be discussed with an orthopedic surgeon.
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While pec tears are becoming more common as people push their bodies to the limit, they can be treated with great outcomes that alleviate pain, restore range of motion, and even allow patients to get back to the sports and training they love. Since not all ruptures are created equal, we take the time to assess your particular injury and perform the type of surgery that will be in your best interest. Our orthopedic office is equipped to handle all types of ruptures and we can fully discuss your case during a consultation. We encourage you to contact our office today to schedule an appointment.