This may come as weird to a lot of people but there are certain injuries that orthopedic surgeons enjoy taking care of. I love taking care of rotator cuff tears, labral tears, meniscal tears, and ACL tears. Pectoralis major ruptures, which are much less common than those above, also fall into this category. It is an injury that is very satisfying to treat. There is such a noticeable deformity that occurs with this injury that when you fix them, people appreciate the strength and the appearance that they regain.
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.
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
Torn Pectoralis Major Tendon
Repair Using Suture Anchors
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.