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

Abstract

Of about 150 cases reported in the literature on pectoralis major ruptures, 108 were selected as presenting enough data to be analyzed for cause, rupture site, injury mechanism, and treatment outcome. We added data on four of our own cases reported here. All patients yet reported have been men. Rupture of the PM occurs most commonly in sports during weight training, weight lifting, or wrestling when the arm is externally rotated and abducted. Most reported ruptures are complete and are located at the insertion to the humerus. Work-related injuries occur more often at the musculo-tendinous junction. The prognosis is related neither to the age of the patient nor to the location of the rupture. Surgical treatment, preferably within the first 8 weeks after the injury, has a significantly better outcome than conservative treatment or delayed repair.

Pectoralis Major Repair With Unicortical Button Fixation And Suture Tape

“…14 Accordingly, nonoperative treatment is generally reserved for elderly patients, 10,11 or patients with suspected partial or muscle belly ruptures and not a rupture of the pectoralis major muscle. 15,16 Although conservative management has been noted to be appropriate in a subset of patients with pectoralis major ruptures, operative treatment is indicated in all young, active patients, regardless of the chronicity of the injury. 1,15,17 Bak et al 15 performed a meta-analysis of 112 cases and reported excellent results in 88% of surgically treated patients with ruptures, compared excellent result in only 27% of patients with ruptures treated nonoperatively.…”

“…15,16 Although conservative management has been noted to be appropriate in a subset of patients with pectoralis major ruptures, operative treatment is indicated in all young, active patients, regardless of the chronicity of the injury. 1,15,17 Bak et al 15 performed a meta-analysis of 112 cases and reported excellent results in 88% of surgically treated patients with ruptures, compared excellent result in only 27% of patients with ruptures treated nonoperatively. Regardless of significantly better outcomes stemming from operative treatment, a case-by-case approach should be undertaken for each patient presenting with a pectoralis major rupture during treatment decision making.…”

Pectoralis Major Repair With Cortical Button Technique

“…1,2 These injuries occur through an indirect mechanism such as forced abduction against resistance, high forces of traction on the arm, and involuntary contraction of the muscle. [3][4][5][6] In weightlifters, particularly when bench pressing, the injury occurs during the eccentric phase of contraction as tension increases. 4,7,8 Professional football players often incur this injury when an arm tackle is attempted on an opposing player.…”

“…3 Because the pectoralis major is a powerful adductor and internal rotator of the arm, 1,9 rupture of the tendon can lead to significant functional deficits and impede highlevel athletic or labor-intensive activities. In addition, rupture of the pectoralis major tendon leads to cosmetic deficits in the anterior axillary fold.…”

“…In this latter group, operative management of a ruptured pectoralis major tendon has been shown to have significant clinical benefits over nonoperative management. 3,[10][11][12] Several surgical techniques to reattach the avulsed tendon back to its footprint in the humerus have been described in the literature. These techniques include transosseous sutures and bone troughs, suture anchors, and endosteal buttons.…”