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More Men At Risk for Pectoralis Major Ruptures

The pectoralis major muscle is the large fan-shaped muscle across the upper chest. It attaches in several places along the breastbone, collarbone, and to the front of the upper arm. Rupture of this muscle is rare but on the rise. Early cases years ago involved men being dragged by a cow during wild-cow milking contests. Today middle-aged male weight-lifters are at greatest risk.

Military orthopedic surgeons offer this review article for sports medicine or general orthopedic surgeons. They say most orthopedists will probably have at least one case of pectoralis major rupture. Understanding the anatomy and recognizing the mechanism of injury will guide treatment decisions.

Bench pressing is the most common cause of pectoralis major rupture. Other causes include wrestling, water skiing, football, and hockey. Less often, falling on an outstretched arm, injury during a car accident, or being hit by a heavy, falling object can cause the same injury.

The authors describe what to look for on exam with this type of injury. They present photographs and MRI images to guide surgeons in making the diagnosis. Treatment depends on the type and location of the tear.

Surgery is advised for most patients with complete rupture of the tendon. This is the only way to regain full strength. Delayed repair may present a problem when scar tissue or muscle wasting occurs. Surgery may not be indicated for older, debilitated adults in nursing homes or long-term care facilities. Partial tears of the tendon or tears through the muscle belly may recover with conservative (nonoperative) care.

The authors offer surgeons advice on both conservative care and various methods of surgical repair. Postoperative care includes protection in a sling. A program of progressive exercises is also prescribed.

References: Benjamin K. Potter, MD, et al. Pectoralis Major Ruptures. In The American Journal of Orthopedics. April 2006. Vol. 35. No. 4. Pp. 189-195.

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