Pectoralis Major Muscle Rupture

Aka: Pectoralis Major Muscle Rupture, Pectoralis Major Rupture, Pectoralis Major Tendon Rupture

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II. Mechanism

  1. Most common in male patients, especially with bench pressing during weight training
  2. May also occur with arm hyperabduction

III. Pathophysiology

  1. Traumatic tear of the pectoralis Muscle tendon or myotendinous junction
  2. Pectoralis major tendon inserts on the proximal Humerus

IV. Findings

  1. Ecchymosis and swelling over the anterolateral chest wall and proximal arm
  2. Curvature lost at anterior axillary fold
    1. Observe with arm abducted to 90 degrees
  3. Chest wall asymmetry
    1. Observe with patient pressing both hands together ("prayer position")
  4. Weakness
    1. Shoulder flexion
    2. Shoulder Internal Rotation

V. Differential Diagnosis

  1. See Shoulder Pain
  2. See Chest Wall Pain

VI. Imaging

  1. MRI Chest and Upper Arm
    1. Test Sensitivity: >51%
    2. Test Specificity: 64 to 75%

VII. Management

  1. Surgical treatment is preferred for acute ruptures
    1. Higher functional outcomes and return to work and sport (when compared with nonsurgical treatment)
    2. Best outcomes when repair occurs within first 6 weeks

VIII. References

  1. Kowalczuk (2022) J Am Acad Orthop Surg 30(7):e617-27 +PMID: 35025841 [PubMed]
  2. McNeely (2025) Am Fam Physician 111(3): 275-6 [PubMed]

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