Pectoralis Major Repair Surgery

The pectoralis major is a large muscle fanning across the upper chest (a second pectoral muscle, the pectoralis minor, sits underneath the pectoralis major).  Fanning across from the collarbone (clavicle) to the breast bone (sternum), the pectoralis major makes up the bulk of the chest muscles and lies under the breast.  A developed pectoralis major is most obvious in males due to the fact that the muscle sits behind the breast, usually more noticeable in women.

The pectoralis major is largely used to control the rotational motion of the arm as well as helping the arm move backwards and forwards.  Injury to the pectoralis major is uncommon but can occur during weight lifting or bodybuilding exercises that put excessive strain on the shoulders and chest, resulting in significant disability in athletes.

Causes of Pectoralis Major Injury

Ruptures and strains (tears) of the pectoralis major are becoming more common due to the increase interest in heavy weight training.  Bench pressing is the most common cause of injury, however other activities such as rugby, football, skiing, other weight training movements or wrestling can also lead to damage.  Pectoralis major injury is most common in men between the ages of 20 and 40.

Pectoralis major injuries usually occur suddenly whilst working at high intensity.  The injury can be felt as a painful snapping sensation at the front of the shoulder and chest, resulting in pain in the chest and upper arm, weakness and muscle deformity causing swelling and bruising.  It is also possible for pectoral injury to develop over time due to repetitive movement involved in certain activities such as CrossFit.

Signs and Symptoms of Pectoralis Major Injury

Generally, pain from a pectoral tear is commonly described as a sudden pain or ripping sensation in the chest or front of the shoulder.  An average tear will be obvious when pressure is applied to the affected muscle, when stretching the affected muscle or while performing movements that involve the affected muscle.

In minor cases, you may be able to continue playing sport and taking part in exercise with a slight increase in the normal aches and pains experienced afterwards.  In severe cases, the level of pain may prevent you from taking part in normal activities.  In the more severe cases, you may experience muscle wastage.  This may result in a visible deformity which will likely require surgery.  Typical symptoms of pectoralis major strain include:

• Bruising
• Swelling
• Muscle spasm
• Muscle weakness
• Pain
• Difficulty moving the affected area

Seek immediate medical attention if your pain occurs while taking part in demanding exercise or activities.

Diagnosis of Pectoralis Major Injury

Your doctor will likely start by carrying out a physical examination and asking how the injury occurred.  This is usually enough to diagnose a pectoral strain as the muscle size and shape is visibly different on the affected side, along with possible bruising on the chest wall.  Your doctor may ask you to rotate and move your arm in order for them to assess the level of pain.

MRI and Ultrasound scans are both effective techniques used to confirm the injury, determine the location and the extent of the damage and rule out other conditions.

Treatment of Pectoralis Injury

In general, most new, minor to moderate cases of a pectoral strain can recover with a few weeks’ rest.  In extreme cases with severe strain, the recovery process may take months to achieve the best recovery.  If you have a complete pectoral tear that requires surgery, it will take at least 6 months before returning to your regular activities and a year before full strength is returned.

Surgery is usually necessary to fix pectoralis major injuries.  Exceptions for surgery include:

• When there is a partial tear of the tendon
• When there is a rupture of the centre of the muscle
• In elderly patients

There are a number of different surgical procedures possible, depending on the severity and the location of the rupture.

Open Surgery

If the tendon has torn off the bone, open surgery may be suggested for you.  The surgery will involve placing large stitches into the affected tendon and attaching them to the arm bone.

Pectoralis Major Transfer

Not everyone is suitable for a major transfer procedure, therefore preoperative planning is crucial before proceeding.  An MRI will have already been carried out, showing your doctor the size of the tear, the quality of the shoulder joint and the quality and bulk of the muscle to be transferred.  The operation is carried out under general anaesthetic and nerve block.  An incision is made and the affected tendons are inspected for any chance of repair.  The pectoralis major tendon is detached, mobilised and moved as high up the humerus as possible before being fixed with strong suture-anchors (fixation devices used to attach ligaments to bone).

Post-Operative Recovery

Following your procedure, the affected arm will be placed in a sling for 4-6 weeks to protect the joint.  You will be encouraged to use ice packs to reduce chest pain and swelling as well as carrying out gentle pendulum motion exercises.  A detailed physical therapy programme may be provided to help regain full shoulder function in the months following your surgery; light weight lifting can be included after 4 months.  A complete recovery can be expected after a year.

To care for your wound you should maintain your post-operative dressing, loosening the bandage if necessary.  It is common for the shoulder to bleed and swell after the operation; apply additional dressing if blood has soaked through the bandage.

To limit the chance of infection you must keep your incision clean and dry, covering the surgical site whilst showering or bathing for 7 days.  You can remove your dressing around a week following the procedure, applying band aid or clean dressing if necessary.

Risks and Complications

All surgical procedures include a certain degree of risk. Complications linked to surgery include:

• Infection
• Continual pain or weakness
• Injury to the nerve
• Reaction to the anaesthetic
• Blood clots or haematoma

Risks related to pectoralis major repair surgery are rare. Possible complications include:

• Weakened bicep muscle
• Stiffness
• Failed transfer
• Re-rupture

Most complications are usually temporary, resolving within a few months and occuring in only a minor percentage of patients.  Any pre-assessment tests performed are aimed to make the risks as low as possible.  Contact your doctor should you be worried about symptoms you are experiencing following your procedure.

Outlook after Surgery

Injury to the pectoralis major tendon is fairly uncommon, but can result in substantial disability in athletes. Surgery should be carried out as soon as possible following injury to lessen the chance of tendon retraction, deterioration of the muscle and scar tissue.

You can use your private medical insurance or pay for your Pectoralis Major Repair Surgery treatment. We offer competitive, fixed price packages. If you are using your health insurance, please contact your insurer first for approval and let them know you’d like to be treated at One Hatfield Hospital.

Need Help?

Pectoralis Major Repair Surgery is available at One Hatfield Hospital. We can book you in to see a specialist Orthopaedic Shoulder Surgeon for an initial consultation, usually within 48 hours.

Why One Hatfield

• Modern purpose-built hospital opened in December 2017
• 0% and low finance options**
• Fast access to diagnostics including MRI, X-ray and Ultrasound
• Private, spacious, en-suite rooms
• Specialist physiotherapy and nursing teams
• Little or no waiting time
• ‘Ultra clean air’ theatres
• Freshly prepared food
• Calm, dignified experience

**Terms and conditions apply

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