Pectoralis major rupture: Presentation of two cases and review of 74 cases

Abstract

P ectoralis major rupture is uncommon. The relative incidence of partial and complete ruptures of the pectoralis major, in acute and in chronic presentations, is not well known, and management of these injuries is not well documented. Weight lifting is the most common cause of pectoralis major rupture, and the bench press exercise accounts for a large portion of occurrences (1-4). Other causes include windsurfing (1,5), football (6,7), wrestling (5,8-10), hockey (11,12) and falls (13)(14)(15). This paper identifies 74 cases reported in the English language literature in the past 34 years and describes two additional cases and their successful management. The relative incidence of partial and complete ruptures in acute and chronic presentations is discussed. Through review of the literature, the most appropriate management was determined. Anatomy, classification of injury and diagnosis are reviewed. CASE PRESENTATIONS Case 1A 24-year-old physical education instructor injured his left pectoralis major. At the time of injury, he had been lifting weights for a number of years. While completing his regular weight lifting program, he was bench pressing a 42 kg barbell (his maximum). As he was abducting his arms in a transverse plane stretching, he felt a burning sensation at the humeral insertion of the left pectoralis major. He did not continue his program. He had persistent symptoms of pain, decreased range of motion, weakness and deformity. One week after injury, ecchymosis became evident in his arm extending to his elbow. Pain was aggravated by shoulder extension and by motion from jogging. This pain limited his active range of motion. He noted weakness and chest cramps when exercising. Also the pectoralis major would bunch into a ball on the chest wall when contracting. The injury prevented the patient from exercising and performing his regular activities as a physical education instructor. The patient did not use anabolic steroids.He sought treatment from several surgeons. The common HYM Chao, RT Manktelow. Pectoralis major rupture: Presentation of two cases and review of 74 cases. Can J Plast Surg 1997;5(2):118-122. Pectoralis major rupture is uncommon. Injury usually occurs from sporting activities. The incidence and management of pectoralis major rupture is not well known, despite 74 case reports in the English language literature over the past 34 years. Two cases of chronic pectoralis ruptures and their successful surgical management are described. A review of the literature shows that most injuries occur at the humeral insertion, and most are complete ruptures. Distinguishing between complete and partial ruptures is important. Complete ruptures are best treated surgically in the acute situation. When chronic complete ruptures present, surgical repair yields fair to good results. Acute partial ruptures can be effectively managed conservatively or with surgery. Chronic partial ruptures can be managed surgically with good results, following unsatisfactory conservative management in the acute situation. Key Wor...