Pec Tears

Who gets pec tears? Looking at the numbers, men are much more likely to get pec tears because of the bulk of the muscle and the stiffness associated with muscular hypertrophy in this region. The decreased flexibility can then result in tearing of the muscle or tendon. Just as in most tendon tears people are between age 30 to 50. The most common mechanism is a heavy bench press where the tendon is stretched as the bar comes down to the chest. This can also occur during ring dips. The deformity is correlated with the amount of muscle or tendon torn. If there is a small deformity it may be just a muscular strain. If there is a significant deformity then the tendon is most likely pulled from the bone. MRI can show the extent of the injury.

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Notice the tears are on the left arms of all these patients

Cosmetic appearance can come into play when dealing with this injury. Cosmetic sounds weird but when things look abnormal people are not thrilled as it is a constant reminder of a deficiency. When the pec tears there is a gap or defect in the axilla where the pec crosses and attaches to the humerus. Now just like any injury and for most of my posts, this repair is not for everyone. However, studies have shown 88% of surgically treated patients with ruptures experienced excellent results versus 27% of those treated nonsurgically. So for young, youngish, Masterish ages and pretty much anyone who wants to lift medium weight objects again for recreation whether it is barbells, dumbbells, or Taco Bells, I would recommend surgery because of the lopsided results in the literature.

Isokinetic testing showed that patients operated on for acute injuries had the highest adduction strength (102% of the opposite side) compared with patients with chronic injuries (94%). Nonoperative treatment resulted in 70% strength return in one study. Pec tears are better dealt with in the acute setting, as in before 6 weeks. The reason is the same for rotator cuff tears and quad or patella tendon tears. The tissue loses its elasticity and retracts making it more difficult to reattach to its intended target. The ends of the tissue also become covered and replaced with a coating of scar tissue. Chronic tears require dissection through scarred and retracted tissue, so time is of the essence to make it easier.

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Depiction of normal anatomy and tendon ripping from bone

The tendon is made up of two heads the clavicular and the sternocostal. Pec tears can occur as a result of a forceful abduction and extension of the arm. In the weightlifting or CrossFit world, this happens most commonly from bench-pressing when the arm is extended. The tendon is lengthened during a bench press and then contraction of the muscle occurs. This is called an eccentric contraction and is typically how tendons tear, just like the Achilles or quad or patellar tendons. In order to reattach the tendon to the bone, two techniques have been described using bone tunnels or bone anchor, which involves less dissection and is less invasive.

 NOTE: GRAPHIC SURGICAL IMAGES BELOW OBTAINED WITH PERMISSION OF PATIENT

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Torn Pectoralis Major Tendon

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Repair Using Suture Anchors

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End Result

The rehab involves allowing the tendon to heal and then pushing for range of motion and then strengthening. Typically it is 6 weeks of passive motion followed by resistance training and active motion with return at 4 to 5 months. One-armed workouts are allowed as outlined in my previous post.

If you are really diligent and take it easy at first, then turn up the volume, hopefully you will be able to do this also post-op. This is a case from one of my patients, Rob O’Brien, who put the brakes on when he needed to then with hard work and determination, got back to this Ninja level at 5 months.

5 Comments

  1. Hi Dr. Rockett,

    Thank you for providing your blog and information to the public; it is very insightful! If you have a moment, would you please provide your feedback to the following questions?

    1. What exactly does the ‘50%’ in “Focal high-grade partial tear of the pectoralis major muscle, which extends for greater than 50% of the muscle thickness” mean? Does it mean that 50% of the entire muscle belly has been ruptured or that a rupture (regardless of cross section area) goes 50%+ of the ‘diameter’ into the muscle belly?

    2. Do these types of injuries require surgery? I was told by an orthopedic surgeon (sports med), PA (sports med), and a chiropractor/PT that this injury will heal to 100% with appropriate rehab.

    Thank you for your time!
    Aaron

    • I would have to see the MRI to say exactly what they mean. sometimes a radiology report can be confusing. You can have 50% of the tendon insertion torn, 50% of the width of the tendon or length, or you can have 50%of the thickness of the muscle belly torn. tough for me to say over the internet. We could arrange for a consult and you can send disc if you want. Kmee@orthopedicsne.com can help

  2. I’m 45 years old and have been a member of crossfit bridgewater for 6 years. I just had surgery for a full thickness supraspinatus tear. My doctor was very vague regarding the results. He said he could not completely repair the damage because of too much shredding at the attachment site. He said I could end up needing a donor patch surgery if after PT I still don’t have full range of motion. I want to be able to do crossfit again after this heals and I’m concerned that enough wasn’t done. I don’t know what to do next. Should I immediately seek a second opinion or move on with PT and see what happens. Jason and Sonia Caldas suggested I contact you. Any information would be helpful. Thanks so much.

  3. I would be happy to take a look you can call office 6175275040 for appt

  4. Dr. Sean,
    Back in August I injured my neck/shoulder crossfitting. I had pain in my right arm that would wake me out of a dead sleep. After seeing my primary, she recommended an orthopedic doctor to take a better look. Seeing that I had radiating pain ranging from my shoulder down to my fingers he couldn’t find a major spot to MRI. The doctor sent me to get an X-ray of my neck; came back with a compressed C6 and C7. So with a little nerve medication, physical therapy and following the Hatch Squat cycle (giving my upper body a rest) the pain went away and I thought I was in the clear. I am back to Crossfit and have noticed I’m having difficulty with dips (including muscle ups), any heavy jerks and push ups. My right arm, the one that was in pain, was significantly smaller than my left. I figured I lost some muscle during the recovery period. To regain this muscle, I have been doing regular gym work (back,bies and tries) on top of Crossfit and I can clearly see that my right pectoral muscle looks like it tore off of my sternum. I sent a friend of mine (and yours) Elaine a video of my chest and she told me to contact/see you.

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About Me

Dr. Sean Rockett is an Orthopedic Surgeon specializing in Sports Medicine. His group is Orthopedics New England with offices in Dedham, Natick and Newton, Massachusetts. Dr. Rockett is a CrossFit Level 1 Trainer and has been a CrossFitter at CrossFit New England since 2007. Dr. Rockett is on the Medical Team for the CrossFit Games and the Northeast Regionals.

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This blog pro­vides gen­eral infor­ma­tion and dis­cus­sion about med­i­cine, health and related sub­jects. The words and other con­tent pro­vided in this blog, and in any linked mate­ri­als, are not intended and should not be con­strued as med­ical advice. If the reader or any other per­son has a med­ical con­cern, he or she should con­sult with an appropriately-licensed physi­cian or other health care worker.

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