pectoralis major rupture an athlete is training doing the bench press big muscles getting strong he is going to push himself and as he brings the weight down to his chest on the final wrap it feels a pop near his shoulder and his arm gives out where there's the fighter he's caught in an arm bar he is doing his best to slip out of it but his arm is being straightened and has a last-ditch effort he turns his upper body away his arm is pulled away from his body as he tries to bring the arm back towards his body and he feels a loud pop near his shoulder and pain that's right this video will be talking about the pack tear the tear of the pectoralis major muscle we will discuss the anatomy involved how it happens what it feels like the treatments and a little on the prevention I'm Dr Lucius pomeranz board certified orthopedic surgeon and a guy who is in the game black belt Brazilian Jiu Jitsu trying to give you all information about common injuries we may see or have had in the context of Combat Sports hopefully you can learn how to use your body better and that I can provide some comfort and knowledge along the way as always see a specialist if you have issues the anatomy the pectoralis major is a big muscle it's the biggest in your chest its job is somewhat counterintuitive though its main functions are to adduct bring the arm into the body and to internally rotate the arm yes it is worked by doing exercises like the bench press and push-ups but to really emphasize the pectoralis muscle you need to focus on bringing the arms in and towards the body and putting some internal rotation dips can do this well I also want you to realize that to maximally stretch the muscle tendon out you need to bring your arm into an abducted away from the body and externally rotated position kind of like being in an arm bar the anatomy of the pectoralis major is pretty unique the muscle has two major components one component comes from the clavicle and is smaller and a large one that comes from the sternum and the ribs each one of these can be broken up into smaller portions with different functions but that's not really necessary to talk about for this these two components attach to the upper humerus essentially at the shoulder on their way to the humerus they have an interesting fan-like structure where some of the anatomists described the fibers coming from the lower end of the chest attaching higher up on the humerus than the fibers coming from higher up this muscle tendon construct can provide a lot of force at various angles of shoulder position it's pretty cool you can feel the tendon of the pectoralis major in the front part of your armpit you can try flexing your PEC and you'll feel the tight band underneath your fingers so how does it rupture usually it is during in The Eccentric exercise where the muscle is Contracting but also lengthening as previously discussed in other videos eccentric exercises are when the most force is being placed on the muscle tendon unit when the forces that the muscle is generating exceed the forces the structure can withstand things fail as a smaller side there is a correlation with this injury happening in association with anabolic steroid use the theory on this is that anabolic steroids make tendons less pliable stretchy it decreases their ability to absorb energy also steroids increase the strength of the muscle faster than the tendon can adapt when the PEC ruptures peepin often will feel and sometimes hear a loud pop along with significant pain in the shoulder and chest there will be a deformity in the chest there will be weakness especially with adduction and internal rotation have a spotter if you are lifting heavy soon there is swelling and often a lot of bruising in the chest and shoulder area sometimes this bruising can go all the way down the arm and down the chest along with the weakness there is often a crampy pain pain when trying to use the muscle the tendon can rupture at the tendon bone interface this is the most common place it can also rupture within the tendon itself at the muscle tendon Junction or even just within the muscle this does influence treatment decisions which we'll be talking about a little bit all right so the injury happened you go see the doctor x-rays are ordered sometimes you can see where the tendon pulled some bone with it the x-rays also rule out other issues that may be going on in that area often an MRI will be ordered this confirms the injury and helps the surgeon see where the injury occurred this helps the surgeon make decisions on how they are going to repair the tissues now the treatment well with the diagnosis confirmed the decision is to operate or not in young active healthy people surgery is often the recommended way to go research shows that without surgery strength could be reduced to a little more than half of normal with surgery most studies show near complete return of strength there is also Improvement in the appearance of the area that being said some people live very active lives without Apec major those with Poland syndrome are born without a PEC major among some other things and you can check out this cool link of someone who's living a pretty full life with Poland syndrome and some people opt to not have surgery some of them might even make it to the UFC another deciding factor is where the injury occurred muscle tendon bone pure muscle tears can be hard to repair and often do not need to be repaired especially if there's been a delay in seeing the doctor similar considerations for the muscle tendon tears though these can do better with surgery sometimes if it dressed early if there is a tear in the tendon or at the tendon bone interface surgery can definitely be very helpful the longer one waits to have the surgery the harder it is to fix it so don't wait if you think you have this injury six weeks in General is seen as the time that things start turning into a more chronic more difficult repair and really it starts getting more hard after even two or three weeks the earlier the better so how is surgery performed a surgical incision is made over the torn area usually this is in the upper shoulder area where the tendon has pulled off the bone this structure is to repair are isolated and important tissues protected then it is a matter of grabbing the torn tendon and bringing it back down to where it needs to go this can be done with sutures through drill holes in the bone suit your anchors or buttons that hold the repair to the Bone the surgeon does have to be careful of other things in the area such as the biceps tendon or blood vessels and nerves grabbing the tendon and putting it to Bone can get predictable and good results grabbing muscle can be more difficult as it is a tissue that does not hold sutures very well and can easily pull apart all right the recovery Now The Healing Begins and the physical therapy starts the recovery process is usually customized to the individual but in general most surgeons will have you wearing a sling for four to six weeks depending on the repair some motion may be started sooner for the most part we will limit the patient from certain activities for at least six weeks raising the arm above shoulder height externally rotating the shoulder and actively flexing the PEC are things that stress the repair and we will slowly progress towards after six weeks strengthening can begin but the emphasis should be on getting your range of motion back Peck strengthening is gradually started but muscles around the shoulder are also rehabbed at three months there are no restrictions you can go after and work on getting full strength it often takes 9 to 12 months before maximal Improvement has been reached so a few things on prevention there are some technical aspects of bench press that you can try like not lowering the bar more than four to six inches above the chest wall as this lowers The Eccentric load that the muscle sees if you go deeper to that and also having your grip not more than one and a half times your shoulder width that also stresses the PEC more The Wider grip you have other things that can help having a good warm up a proper warm-up that works the chest and shoulder of course there's the theoretical risk of steroids you cannot do those and in the world of Combat Sports you cannot eliminate the risk of injury there are explosive movements that put your body into high levels of stress however you can keep your muscles strong and flexible over large ranges of motion as always take care of your body and it will take care of you please like share subscribe I'm Dr Lucius pomerance and I'm encouraging you all to keep moving