Pectoralis Major Rupture

Introduction

• Discussion on pectoralis major muscle rupture in athletes
• Common scenarios:
  • Weightlifting (bench press)
  • Combat sports (arm bar submission)
• Speaker: Dr. Lucius Pomeranz, board-certified orthopedic surgeon, black belt in Brazilian Jiu Jitsu

Anatomy of the Pectoralis Major

• Description: Largest muscle in the chest
• Functions:
  • Adduction (bringing the arm into the body)
  • Internal rotation of the arm
• Training: Emphasizing internal rotation is crucial (e.g., dips)
• Structure:
  • Two major components:
    • Clavicular (smaller component)
    • Sternal (larger component from sternum and ribs)
  • Tendon attaches to the upper humerus; unique fan-like structure

Mechanism of Injury

• Common Cause: Eccentric exercises (muscle contracting while lengthening)
• Rupture: Occurs when muscle forces exceed structural limits
• Associated Risks:
  • Anabolic steroid use may lead to less pliable tendons
  • Faster muscle strength increase vs. tendon adaptation

Symptoms of a Rupture

• Loud pop or feeling of a tear
• Significant pain in the shoulder and chest
• Visible deformity in the chest
• Weakness in adduction and internal rotation
• Swelling and bruising that may extend down the arm
• Crampy pain upon muscle use

Diagnosis

• Initial Assessment: Consult a doctor
• Imaging:
  • X-rays to rule out other issues
  • MRI to confirm the injury and locate its severity

Treatment Options

• Surgery vs. Conservative:
  • Surgery is often recommended for active young individuals
  • Non-surgical treatment can result in significant strength loss
  • Some individuals live actively without surgery (e.g., Poland syndrome cases)
• Factors Influencing Surgery:
  • Type of tear (tendon-bone interface vs. muscle-tendon junction)
  • Duration before seeking treatment

Surgical Procedure

• Incision Location: Upper shoulder area
• Repair Method:
  • Tendon reattached to the bone using sutures, anchors, or buttons
• Considerations: Careful of surrounding structures (biceps tendon, blood vessels, nerves)

Recovery Process

• Initial Phase: Sling for 4-6 weeks
• Motion Limits: Avoid raising arm above shoulder height; gradually progress
• Rehabilitation:
  • Begin strengthening after 6 weeks
  • Full activity typically resumes after 9-12 months

Prevention Strategies

• Technical Lifting Tips:
  • Limit bar lowering to 4-6 inches above the chest
  • Grip width should not exceed 1.5 times shoulder width
• Warm-Up: Essential before workouts
• Anabolic Steroid Awareness: Risks associated with use
• Maintain Muscle Flexibility: Prevent injury through diverse range of motion

Conclusion

• Importance of taking care of the body to prevent injuries
• Encouragement to keep moving and stay active
• Reminder to like, share, and subscribe for more information