Pectoralis major tendon tears: functional outcomes and return to sport in a consecutive series of 40 athletes

doi:10.1016/j.jse.2016.07.018

Journal of Shoulder and Elbow Surgery

Volume 26, Issue 3, March 2017, Pages 458-463

https://doi.org/10.1016/j.jse.2016.07.018 Get rights and content

Background

There are limited data on the outcomes of surgically repaired pectoralis major tendon (PMT) tears. The purpose of this study was to report the functional outcomes, return to sport, and second surgery rates in a consecutive series of PMT tears.

Methods

Forty patients with acutely repaired PMT tears were retrospectively identified. Follow-up was conducted with functional outcome scores and adduction strength testing at final follow-up. Return to sport and incidence of subsequent surgery were also recorded.

Results

The average age of the patients was 34.4 years (range, 23-59 years). Average follow-up was 2.5 years (range, 2-7.0 years). Twenty-three injuries (58%) occurred in the nondominant extremity. Bench press (n = 26) and contact sport participation (n = 14) were the most common mechanisms. Postoperative Single Assessment Numeric Evaluation scores averaged 93.6 (range, 62-100), with patient satisfaction of 9.6 of 10 (range, 6-10). All athletes returned to preinjury level of function approximately 5.5 months postoperatively (range, 4.5-6.5 months); 23.1% and 2.6% described mild or moderate difficulties with sport participation. Isokinetic strength evaluation revealed an average decrease of 9.9% (range, −18% to 41%). Application of the Bak criteria revealed 37% excellent, 26% good, and 37% fair outcomes, with most in the fair group reporting cosmetic concerns. Removing cosmesis, 46% scored excellent, 37% good, and only 17% fair. Three athletes required a second surgical procedure (7.5%).

Conclusions

Surgical repair of PMT tears resulted in high patient satisfaction, with excellent restoration of function and adduction strength, early return to sport, and few reoperations, albeit with the potential for mild cosmetic concerns.

Section snippets

Methods

We retrospectively reviewed prospectively collected data on all PMT tears between March 2008 and March 2016. Our inclusion criteria included young, active male patients with acutely treated (<8 weeks) PMT tears with a minimum of 2 years of follow-up. Exclusion criteria included chronic tears (n = 6), defined as those treated >8 weeks after the initial injury, and revision PMT repairs. We identified 40 patients who met inclusion criteria, and none of the available patients were lost to follow-up.

Results

All 40 patients who underwent PMT repair were male and included 4 professional athletes and 36 recreational athletes (Table II). The average age of the patients was 34.4 years (range, 23-59 years), with an average follow-up of 2.5 years postoperatively (range, 2-7.0 years). Twenty-three injuries occurred in the nondominant extremity (57.5%), whereas 17 (42.5%) occurred in the dominant extremity. Bench press (n = 26) and sport participation (n = 14) were the most common mechanisms of injury.

Discussion

Although historically rare, pectoralis major tendon injuries have occurred with increasing frequency in recent years. Several studies have demonstrated the superiority of surgical repair compared with nonoperative treatment1, 2, 7, 13, 15, 17; however, specific information on functional outcomes and adduction strength after PMT repair is limited. In this single-surgeon series, which represents the largest cohort of PMT repairs reported to date, surgical repair using unicortical buttons resulted

Conclusion

As demonstrated in this consecutive series, which represents the largest cohort of PMT repairs reported to date, surgical repair resulted in 96% patient satisfaction, with 83% good to excellent restoration of function and adduction strength, albeit with the potential for mild cosmetic concerns. The athletes returned to sport on average at 5.5 months postoperatively. Three patients required a second surgery for an incidence rate of 7.5%.

Disclaimer

The authors, their immediate families, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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Surgical repair and rehabilitation of a ruptured pectoralis major muscle in a professional footballer – A case report
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Pectoralis Major ruptures normally occur in activities and sports such as powerlifting and American football or rugby. It is a rarely reported phenomena in professional footballers. Surgery is normally considered the choice of management to enable a safe return to play with conservatively managed ruptures often resulting in significant strength deficits. This case report highlights the management of a pectoralis major rupture in a professional footballer.
A 27-year-old professional footballer sustained a left pectoralis major rupture after falling to the floor. A subsequent MRI reported a 5cm retraction of the pectoralis major tendon from its attachment at the humerus. Following a consultation with an orthopaedic surgeon the player underwent a pectoralis major surgical repair. Following surgery, the player underwent a rehabilitation programme under the care of the club physiotherapist. Return to play testing included a handheld dynamometer test, closed kinetic chain upper extremity test and progressive falling activities. The player returned to full contact training after 87 days.
This case study demonstrates a successful return to professional football following a pectoralis major rupture and supports the notion that surgical repair of these injuries produces a favourable outcome in professional athletes when returning to sport.
Pectoralis major rupture repair with Achilles tendon allograft in 22 bodybuilding athletes
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Pectoralis major tendon rupture rate is increasing due to increased tendency to bodybuilding exercises, specially the bench press workout, and weight-lifting. The aim of this study was to determine the results of pectoralis major rupture repair with Achilles tendon allograft in bodybuilding athletes.
In this case series study, 22 bodybuilding athlete patients (24 pectoralis major ruptures) were undergone open surgical repair during January 2016 till December 2020. 21 ruptures were chronic (2 ruptures were revision) and 3 ruptures were acute. Surgical method was based on Achilles tendon allograft used to augment the ruptured site for lengthening the shortened tendon.The results were analyzed using Bak's criteria and Constant score in pre operation visit and 6th and 12th months and in the last follow up.
All cases were male with the mean age of 32.1 ± 5.4. The mean duration time between injuries to surgery was 37 ± 46 month (1–182 months). Return to professional sport began at 10.9 ± 2.8 months after surgery in which 16 cases (66.7%) have returned to their pre surgery bench press workout records. No infection or hematoma occurred. At the final follow-up, Bak criteria demonstrated excellent, good and fair in 4, 18 and 2 shoulders respectively. The constant score increased from 87.9 ± 7.9 in pre operation visit to 92.7 ± 6.4 in the last follow up (P < 0.001).
It seems that our surgical method is an effective approach in cases with acute or chronic pectoralis major ruptures.
Level IV
Pectoralis Major Tendon Rupture While Bouldering
2023, Wilderness and Environmental Medicine
Citation Excerpt :
Pectoralis major tendon ruptures are rare injuries but may be increasing, with a total of 365 cases reported between 1822 and 2010 and 76% of cases reported after 1990.5 When present, these injuries generally occur in 20- to 40-y-old male athletes and have been associated with bench press or high-contact sport participation.5-8 Of the 365 cases described by ElMaraghy et al,5 11 were of women, 10 of whom were nursing home residents, suggesting a different mechanism of injury in this group.
Pectoralis major tendon ruptures are rare injuries. We present a case of a pectoralis major tendon rupture incurred while bouldering that required surgical repair. The diagnosis of pectoralis major tendon rupture relies predominantly on clinical examination. Among athletes, outcomes after surgical repair are superior to those after nonoperative therapy in most cases of complete tendon rupture. Although infrequent, pectoralis major tendon ruptures can occur while climbing, and early recognition and expedited surgical treatment are paramount to maximize functional recovery.
Clinical Outcomes of Pectoralis Major Tendon Repair with and without Platelet-Rich Plasma
2022, Arthroscopy, Sports Medicine, and Rehabilitation
To assess clinical outcomes following pectoralis major tendon (PMT) repairs and to compare outcomes of PMT repairs augmented with and without leukocyte-poor platelet-rich plasma (LP-PRP).
A retrospective review of prospectively collected data was performed of patients who underwent a PMT repair from May 2007 to June 2019 with a minimum of 2-year follow-up. Exclusion criteria included revision PMT repair, PMT reconstruction, and concomitant repair of another glenohumeral tendon/ligament. LP-PRP was injected surrounding the PMT repair before wound closure. Patient-reported outcome (PRO) data were collected preoperatively and evaluated at final follow-up using the American Shoulder and Elbow Surgeons Score (ASES), Single Assessment Numeric Evaluation Score (SANE), Quick Disabilities of the Arm, Shoulder and Hand Score (QuickDASH), and Short Form 12 physical component summary (SF-12 PCS), patient satisfaction with outcomes.
Twenty-three men (mean age, 38.6 years; range, 20.5-64.3 years) were included in the final analysis. Mean time from injury to surgery was 30 days (range, 3-123 days). Follow-up was obtained for 16 of 23 patients (70%) at a mean of 5.1 years (range 2.0-13.0 years). Significant improvement in PROs was observed (ASES: 59.0 → 92.4, P = .008; SANE: 44.4 → 85.9, P = .018; QuickDASH: 44.4 → 8.5, P = .018; and SF-12 PCS: 42.5 → 52.6, P = .008). Median satisfaction was 9 of 10 (range, 6-10). Patients receiving LP-PRP had superior ASES (99.6 vs 83.0, P = .001), SANE (94.8 vs 74.6, P = .005), QuickDASH (0.24 vs 19.1, P = .001), and patient satisfaction (10 vs 9, P = .037) scores compared with those without PRP. PROs were unchanged based on chronicity, mechanism of injury, or tear location. One patient had revision surgery at 3.4 years due to adhesions.
PMT repair produces improved PROs at final follow-up when compared with preoperative values.
Level III, retrospective comparative therapeutic trial.
Pectoralis muscle injuries in Major and Minor League Baseball
2022, Journal of Shoulder and Elbow Surgery
Although shoulder and elbow injuries in professional baseball players have been thoroughly studied, little is known about the frequency and impact of pectoralis muscle injuries in this population. The purpose of this study was to use the official league injury surveillance system to describe pectoralis muscle injuries in professional baseball players in Major League Baseball (MLB) and Minor League Baseball (MiLB). Specifically, (1) player demographic characteristics, (2) return to play (RTP), (3) injury mechanism, (4) throwing- and batting-side dominance, and (5) injury rate per athlete exposure (AE) were characterized to guide future injury prevention strategies.
The MLB Health and Injury Tracking System database was used to compile all pectoralis muscle injuries in MLB and MiLB athletes in the 2011-2017 seasons. Injury-related data including diagnosis (tear or rupture vs. strain), player demographic characteristics, injury timing, need for surgical intervention, RTP, and mechanism of injury were recorded. Subanalyses of throwing- and batting-side dominance, as well as MLB vs. MiLB injury frequency, were performed.
A total of 138 pectoralis muscle injuries (32 MLB and 106 MiLB injuries) were reported in the study period (5 tears or ruptures and 133 strains), with 5 of these being recurrent injuries. Operative intervention was performed in 4 athletes (2.9%). Of the 138 injuries, 116 (84.1%) resulted in missed days of play, with a mean time to RTP of 19.5 days. Starting pitchers sustained the greatest proportion of pectoralis injuries (48.1%), with pitching being the most common activity at the time of injury (45.9%). A majority of injuries (86.5%) were sustained during non-contact play. Overall, 87.5% of injuries occurred on the player’s dominant throwing side and 81.3% occurred on the player’s dominant batting side. There was no significant difference in the rate of pectoralis injuries in the MLB regular season (0.584 per 10,000 AEs) vs. the MiLB regular season (0.425 per 10,000 AEs) (P = .1018).
Pectoralis muscle injuries are most frequently non-contact injuries, most commonly sustained by pitchers. An understanding of these injuries can guide athletic trainers and management in expectation management and decision making, in addition to directing future efforts at injury prevention.
Management of pectoralis major muscle injuries
2022, Surgical Techniques of the Shoulder, Elbow, and Knee in Sports Medicine, Third Edition
Pectoralis major muscle tears are injuries associated with significant morbidity and require surgical treatment in the young, active population to permit a return to pre-injury activity level. History and physical examination are usually sufficient to make a diagnosis, though if there is a question, an MRI with particular attention towards capturing the distal extent of the pectoralis major insertion can be a useful aid. Surgical repair is best in the acute period following injury with multiple types of fixation techniques described. Chronic ruptures or acute injuries involving a tear at the myotendinous junction have successful midterm outcomes in the recent literature that appear to be more favorable in those treated surgically than those treated nonoperatively. Surgical repair or reconstruction appears to have a reliable return to previous activity with an acceptable complication profile that includes re-rupture and deep infection.

View all citing articles on Scopus

: The Institutional Review Board of the Hospital for Special Surgery approved this study: No. 2013-025-AM1.

View full text

Pectoralis major tendon tears: functional outcomes and return to sport in a consecutive series of 40 athletes

Background

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusion

Disclaimer

J Shoulder Elbow Surg

Rupture of the pectoralis major muscle

Am J Sports Med

Rupture of the pectoralis major: a meta-analysis of 112 cases

Knee Surg Sports Traumatol Arthrosc

Pectoralis major rupture: diagnosis and treatment

Clinical considerations for the surgical treatment of pectoralis major muscle ruptures based on 60 cases: a prospective study and literature review

Am J Sports Med

Pectoralis major muscle rupture in athletes: a prospective study

Am J Sports Med

Repair of pectoralis major ruptures: single-surgeon case series

Orthopedics

Pectoralis major tears: comparison of surgical and conservative treatment

Br J Sports Med