Pectoralis major tendon ruptures: when to operate

Abstract

The treatment of pectoralis major tendon ruptures has been the subject of much debate. The classical history of the injury is forced abduction and external rotation. The cases of two patients (an amateur rugby union player and a recreational snowboarder) are reported. The diagnosis was made by clinical examination in both patients, and both were operated on more than two weeks after injury. After surgery and a graduated rehabilitation programme, both men were able to return to their sporting activities. These two cases highlight the advantage of operative management in this uncommon condition.

A systematic review and comprehensive classification of pectoralis major tears

“…2,49,62 It is a significant contributor to the aesthetic appearance of the chest wall and the contour of the anterior axillary fold. We identified 4 cadaveric studies before 2009 that examined the PM anatomy in detail.…”

“…6). 17,60,62 Intraoperative classification may be difficult with chronically scarred partial-thickness tears, because the torn tendon can often atrophy and retract (''turtle'') intramuscularly. In our clinical experience, we have found it helpful to remember the normal anatomy when characterizing the pathologic condition.…”

Chronic bilateral pectoralis major ruptures and reconstruction with allograft

“…7 In the past most authors preferred to treat this injury nonoperatively, but surgical treatment has been shown to give excellent results even in chronic cases. 7,11,14 The preferred technique for surgical repair is direct repair of tendon to bone or remaining tendon via modified deltopectoral approach. 14 Despite a delay in diagnosis and treatment of pectoralis major ruptures, most patients usually have a successful repair and tendon graft is rarely necessary.…”

Loss of pectoral muscles: Treatment with latissimus dorsi muscle rotational flap

“…Some believe that this injury does not need to be treated surgically, whereas others have argued that surgical repair must be done in the acute stage. 1,5,14,16 Surgical treatment of pectoralis major ruptures includes primary repair of the ruptured site or reattachment of the tendon to the insertion on the humerus. 1,5,8,16 Although there has been a lack of objective testing, surgical treatment has been shown to be consistent with subjective and objective improvement in strength and better functional outcome.…”