Your pectoral muscles sit on your anterior chest wall. The larger muscle, the Pectoralis major, is a powerful elevator, internal rotator and adductor (pulls in and internally rotates your arm as well as helping forward flexion). The muscle has two heads, the sternocostal head (larger) and the clavicular head. The tendons of your pectoralis major insert into the front of your upper arm (humerus) and the muscle forms the front wall of your armpit. Rupture involves tearing of the tendon normally just by its insertion into the bone. Often, only one of the two heads of your pec major muscle gets ruptured.
Pec major rupture is fairly rare and almost always occurs in men, mostly those over 30 years old. Normally a heavy-weight gym bench press in the ‘negative’ phase (weight being lowered onto chest) is to blame. This is because the pec. muscle is being placed under severe eccentric (fibres getting longer as they fire) load during this exercise.
Some body-builders use steroids or growth hormones to accelerate their muscle gain. These drugs increase the risk of rupture, as the muscle grows faster than the tendon can, risking overload of the tendon fibres.
Patients typically report a sudden pop, with severe pain and loss of function. There is often bruising in the armpit and upper arm. There may be alteration of the armpit contour and the nipple on the affected side may drop slightly compared to the uninjured side. Patients may feel weakness in pressing forwards and pulling in with their affected arm.
X-rays are usually normal, but an MRI or Ultrasound scan can confirm the diagnosis.
Photographs of a bodybuilder presenting with a 10 week-old right pec major rupture. top image - relaxed postion: note the lower position of the right nipple and subtle alteration of the armpit crease. bottom image: when the muscle is tensed the defect becomes more obvious with the muscle belly retracting medially
35yr old athletic male presenting 18 months after right pectoralis major rupture. Note the subtly altered axillary contour at rest and how this is made obvious with voluntary contraction. Patient was frustrated by weakness on push ups, pull ups, bench-press and aching.
Most patients are keen for surgery to restore both their function and cosmesis. Studies report excellent functional outcome with surgical repair, with over 95% of normal strength being restored. These results are significantly better than non-operative treatment, although some patients chose not to have surgery. Without surgery full strength will not be restored and the anterior armpit fold will remain asymmetrical, although for some this is not a problem.
If your tear is acute (less than a few weeks old), it is normally feasible to perform a direct repair. You will have a general anaesthetic and a regional block. Through an approximately 7cm open incision at the front of your shoulder, your ruptured tendon will be retrieved and re-fixed to your humerus (arm bone) where it belongs. The fixation uses very strong sutures and metal anchors or buttons fixed within your bone.
If your tendon has been ruptured for some time (more than a couple of months) the tissue may not be repairable directly as it retracts and scars up. In this case you may require an allograft (tendon tissue from a donor) to span the gap between your ruptured pec major and your humerus bone. This works well, but rehab is slower and the cosmetic and power results are less good than a primary repair.
You will go home the same day in a sling. You will need to use this sling for six weeks to protect your repair. You will be able to do desk-work in your sling after about 2 weeks, but you will not be able to drive for about 6 weeks. At six weeks you can begin to move your arm more, but you must not do any resistance training until three months. By six months all restrictions will be lifted.
This procedure is generally safe. However, as with all surgery, there is a small risk of infection, bleeding, shoulder stiffness and nerve injury. Re-rupture after repair is very rare if you follow the rehabilitation protocol. The risk of anaesthetic is generally low as most patients with pec. major rupture are young and fit.
Mr Granville-Chapman was very polite and his examination and explanation of my symptoms and expected treatment was thorough
I found Mr Granville-Chapman to be very knowledgeable and professional. He put me very much at ease and explained all the options that I have thoroughly. He also told me to look for further information on the condition and procedures that I needed on his website, which gave lots of information and detail. It was also easy to understand for those without a medical background. I would highly recommend his services to anyone that has shoulder problems and requires a solution.
I attended for a repair of my right bicep tendon. After a thorough examination, Mr Granville-Chapman arranged an operation to be undertaken within 2 days which was extremely quick; he explained his reasoning which was both thorough and reassuring, explaining both the options of undergoing surgery and deciding to undertake conservative management.On the day of the surgery Mr Granville-Chapman was again very reassuring as although this is minor surgery I was still somewhat apprehensive. He came to fully explain the procedure and afterI woke up was quick to check on how I was doing.Overall I am very happy with the careMr Granville-Chapman
I have been very pleased with my treatment so far. Mr Granville-Chapman combines brisk efficiency with a pleasant, sympathetic manner. My operation, however, is still to come ...
From the initial consultation, through surgery on a fractured wrist, and now post-operative follow up, it has been a very positive and reassuring experience with Mr Granville-Chapman. I would have no hesitation in recommending him to someone else.
A first class clinician. A skilled surgeon with an excellent bedside manner.
A very pleasant Consultant who knows exactly how to make pain go away.
Mr Granville - Chapman has an excellent bedside manner. He engaged with my 12 year old son at an appropriate level and took the time to ensure that he understood the procedure and answer all his questions. He is thoroughly professional and I would not hesitate to recommend him.
I have been very pleased with the attention I have received. Mr. Granville-Chapman has reassured me that my symptoms are normal. It is very easy to make appointments that suit me.
Mr Granville chapman I found be caring informative and professional I would recommend him to all if you have a problem don't hesitate to contact him you won't be disappointed.
I recently broke my right clavicle in a mountain bike accident and it was repaired by Mr Granville-Chapman by adding a plate on top of the bone. Having just finished the last post-op consultation, I can confirm that I have been very happy with the process all along. In particular, Jeremy took time to explain in detail why a plate was needed, what the procedure would entail, and also was very patient answering my questions comprehensively beforehand and after during the recovery phase. Would certainly trust this competent surgeon to fix any future fractures I might sustain.
Mr Granville-Chapman has looked after my 15 year old son brilliantly, explaining the surgery, recovery and best way forward, and Kate has been very supportive helping with logistics etc, thank you so much.
So far my experience with Mr Jeremy Granville-Chapman has been personal and informative with regard to the operation I will be having. I feel confident that my operation will be a success and for this reason I am very happy to have Mr Jeremy Granville-Chapman as my consultant.
Very knowledgeable and helpful. Takes the time to make sure you're getting the treatment you need.
Mr Jeremy Granville -Chapman is not only a highly skilled consultant but is able to put you straight away at ease .My appointments were arranged very swiftly which was great, when you are experiencing severe pain. I am very happy with my treatment so far . many thanks to everyone who was involved in my treatment.
Polite, helpful, professional. Makes an effort to ensure full understanding of issues and procedures to be done. Highly satisfied
Very pleasant. Clear, careful explanations & options/possibilities. I feel well informed, and happy that my concerns are being well addressed, with a plan of review of the symptoms.
Excellent advise with everything explained clearly and a successful treatment which has benefited be greatly.
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