The pectoralis major is the large chest muscle that helps move the arm across the body, rotate the shoulder inwards and generate pushing strength. The tendon attaches this muscle to the upper arm bone (humerus). A pectoralis major tendon rupture can occur during heavy lifting, weight training, contact sport or a sudden force through the arm. It may cause a tearing or popping sensation, bruising, swelling, weakness, pain, and a change in the shape of the chest or front of the armpit. Some partial tears or injuries in lower-demand patients may be managed without surgery. However, pectoralis major tendon repair may be recommended for complete tears, active patients, athletes and manual workers, or when strength and function are significantly affected.
Pectoralis major tendon repair is a surgical procedure used to reattach the torn tendon to the upper arm bone. The aim of surgery is to restore the tendon’s position, improve strength and support a structured recovery and rehabilitation program.
The pectoralis major is the large, fan-shaped muscle at the front of the chest. Its tendon attaches the muscle to the upper arm bone (humerus) and helps generate strength when pushing, lifting, bringing the arm across the body and rotating the shoulder inwards. A pectoralis major tendon rupture occurs when the tendon fibres partially or completely tear. The injury most commonly occurs near the tendon’s attachment to the upper arm bone, although tearing may also occur within the muscle or where the muscle joins the tendon.
Pectoralis major injuries may be classified as:
Partial tear
Only part of the tendon or one portion of the muscle is torn. Strength and function may be affected, but some tendon fibres remain intact.
Complete tear
The tendon is fully detached or disrupted. The muscle may retract towards the chest, resulting in weakness and a visible change in the contour of the chest or front of the armpit.
The injury often occurs when the muscle is placed under high tension, particularly while the arm is extended away from the body and rotated outwards. The bench press is a commonly reported mechanism, especially while lowering a heavy weight. The effect of a rupture depends on the location and extent of the tear, the amount of tendon retraction and the patient’s activity requirements. Complete tears may cause significant loss of pushing strength and can affect weight training, sport, manual work and everyday upper-limb function.
A complete rupture may cause a noticeable loss of the normal fold at the front of the armpit, together with reduced pushing strength. Partial tears may cause less obvious changes but can still result in persistent pain and weakness. Symptoms can sometimes become less painful after the initial bruising and swelling settle, even though the tendon remains torn.
Early specialist assessment is therefore important, particularly when there is visible deformity, significant weakness or difficulty using the arm.
Repair is easier when performed soon after injury, before the tendon becomes shortened or surrounded by scar tissue. However, longstanding tears may still be repairable, sometimes requiring a tendon graft or a more complex reconstruction.
Dr Richard Dallalana will consider the imaging findings, time since injury, tendon quality, degree of retraction and individual work or sporting requirements when recommending surgical or non-surgical treatment.
Pectoralis major tendon repair is performed under general anaesthesia. During the procedure, Dr Dallalana makes an incision near the front of the shoulder and upper arm to locate the torn tendon. Any surrounding scar tissue is released, and the tendon is carefully mobilised so it can be returned to its normal attachment on the upper arm bone (humerus).
The original tendon attachment site is prepared to create a suitable surface for healing. Strong sutures are placed through the tendon, which is then secured back to the bone using a fixation method such as:
Several accepted fixation techniques may be used, with the choice depending on the injury pattern, tendon quality and Dr Dallalana’s preferred surgical approach. For a recent injury, the tendon can often be repaired directly to the bone. In a longstanding rupture, the tendon may have retracted or developed scar tissue, making the procedure more complex. In some cases, a tendon graft may be required to bridge the gap and reconstruct the attachment. Once the tendon has been securely reattached and appropriate tension restored, the incision is closed and covered with a waterproof dressing. The arm is then placed in a sling to protect the repair during the early healing period.
The aim of surgery is to restore the tendon to its normal position, improve chest and shoulder contour, and support recovery of pushing strength and upper-limb function.
Recovery after pectoralis major tendon repair is a gradual and carefully protected process. The repaired tendon requires time to heal securely back to the upper arm bone before it can tolerate stretching, resistance or heavy loading.
Return-to-sport decisions should be individualised according to the demands of the sport, whether contact is involved and your functional recovery.
Before returning to demanding physical work, full gym training or contact sport, patients should have:
Outcomes can also be less predictable when repair is delayed and the tendon has become shortened, retracted or surrounded by scar tissue. Successful recovery depends on protecting the repair while the tendon heals. Heavy lifting, pushing, bench pressing and contact sport must be avoided during the early rehabilitation period, as returning too quickly may place excessive stress on the repair. The likelihood of complications depends on the severity and age of the injury, tendon and muscle quality, the repair or reconstruction required, general health and adherence to rehabilitation.
Dr Richard Dallalana will discuss the expected benefits, relevant risks and non-surgical alternatives before surgery.
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