Pectoralis Major Muscle Ruptures

Rupture of the pectoralis major muscle is a rare injury, with less than 200 reported cases in the literature since its initial description in 1822 by Patissier. The majority of these cases have been documented over the past few years, showing the growing appreciation and awareness of this injury. Injuries are most commonly sustained by young men during athletic or weightlifting activity, which comprise a large proportion of our military population. Ruptures usually occur when the muscle is eccentrically contracting under an extensive load. However, direct trauma to the muscle may also result in injury. Acute symptoms often consist of swelling, ecchymosis and pain over the affected axilla and pectoral region, and diminished strength. On physical examination, typical findings include an abnormal contour of the axilla and reduced adduction and internal rotation strength. Clinical diagnosis can be supported with imaging. Magnetic resonance imaging is the modality of choice, adequately showing the location and extent of injury. Tears are most common at the tendon or myotendinous junction. In young active individuals, ruptures of the pectoralis major muscle have the best results after surgical repair, acutely or delayed. Conservative treatment is usually reserved for muscle belly tears or elderly, sedentary individuals.