One of the Most Common (and Serious) Injuries I see in Mixed Martial Arts

The sport of Mixed Martial Arts (MMA) continues to grow rapidly. As the sport grows the number of injuries we see in it have also increased. Just like other sports there are unique injuries that can occur. These injuries are unique to the fact that in MMA you are dealing with 2 opponents trying to subdue, punch, wrestle, grapple or simply get away from each other. For example, a classic knee injury that occurs in soccer is the ACL tear. Baseball pitchers frequently injure a particular ligament in their elbow. Snowboarders will tend to fracture a particular area of their foot. Gymnast can injure a specific cartilage in their wrist joint. In MMA they get tendon ruptures.

I have been treating MMA athletes for the last 7 years. I see MMA athletes at all levels of the sport both amateur pro and the hard core weekend warrior. This experience has allowed me to see patterns of injury that I previously did not know existed. So what specific tendon injury is specific to MMA?

pec major body

PECTORALIS MAJOR TENDON RUPTURE : The pectoralis major tendon or “pec” major tendon (pectus = breast) is a thick, fan-shaped muscle situated at the anterior chest of the human body. It makes up the bulk of the chest muscles in the male athlete. Tears of the pec major tendon are rare in the normal population. In the normal population they can occur from power benching. The patient is usually older. I also see these injuries in police officers who injure themselves while trying to control a combative suspect. In general this injury is not very common. More recently however in the MMA population they are much more common, occur at a younger age and have a different type of mechanism.

Mechanism: The typical tear occurs when a fighter is protecting his arm from the armbar sumission. During this action the fighter is trying to keep his flexed arm against his body while the opponent attempts to pull it away. This creates what is called a violent eccentric contraction. When the opponent is successful at straightening out the arm the pec rips the tendon off the bone.

Symptoms: Most of my patients who have sustained a pec major tendon tear have felt or heard a pop or rip from the anterior chest wall or anterior shoulder. There will be bruising down the front of the arm and the chest wall.

.Bruise arm pec major

It will be very painful to move the arm away from the body. Initially there will be significant swelling however as the swelling subsides the injured chest wall will look different that the opposite side. Sometimes their is a divot like defect. Sometimes the injured pec looks lower than the other side. The diagnosis can sometimes be make by history and physical alone.

Asymmetrical chest wall

Unfortunately pec major tears often get mis-diagnosed. This is usually because the physician is not expecting the injury (remember they are rare in non MMA population) or the tear was not well visualized on the shoulder MRI.

Pec tear MRI

The diagnosis and treatment is better managed when the physician has a high level of suspicion orders and expedites an appropriate MRI which targets the pec major tendon.

Treatment: Pectoralis major tendon ruptures in young patients are serious because they usually require an expedited surgical repair. In my experience all of the tears I have seen in MMA athletes have involved the tendon tearing off the bone. During surgery the torn tendon is pulled back to the bone and re-attached either with drill holes or anchors. Surgery is more likely to be successful if the tear is operated within the first 2 weeks. The torn tendon retracts (shrinks) the longer the tear goes without repair. Full tears that are not re attached will lead to permanent weakness.

Pec major repairDiagram of surgical repair

Pec Incision Surgical incision in armpit crease

Pec anchorsMy preference is to re attach the tendon using an anchor technique that acts like a “molly bolt” type of construct.

This is a “bullet proof” type of repair which firmly secures the torn tendon to bone and allows early movement. A sling is usually worn for 6 weeks. An excellent result can be obtained after a timely surgically repair, adherence to post operative instructions, good nutrition and excellent rehabilitation.

 

IMPORTANT POINTS:

  • Usually occur when a flexed elbow and shoulder is pulled away from the body.
  • You will hear or feel a rip or pop over the front for the shoulder and chest wall.
  • If you think you tore your pec major you probably did.
  • Do not be fooled by the fact that your pain and swelling are going down. If the pec major tendon is torn it stays torn.
  • You need to see an Orthopaedic Surgeon as soon as possible.
  • Time is of the essence and critical for a successful surgical outcome.

Good luck with your training and may you always stay healthy.

Mark W said on Yelp regarding his pec major treatment:
Dr. Mora came highly recommended from a Dr that treats UFC fighters after injury. I was told by the Dr that Dr Mora “saves professional athletes careers” and that he is the man to go to. I sustained a peck major tear during a fight. After the MRI, I visited Dr Mora for his recommendation. Mora read the MRI report and didn’t agree with what the doctor had diagnosed. Dr. Mora wasn’t seeing what the doctor had written in his findings. Dr. Mora called the Dr and the 2 conversed for some time. Mora ordered a 2nd MRI and Mora’s diagnoses was correct. Surgery went extremely well. My scar is minimal because the manor in which he made the incision and sutured it closed. He also made the incision in my underarm crease so it is nearly invisible. The complete process was amazing and I highly recommend Dr Mora if your injured

 

Steve A. Mora, M.D.
Orthopaedic Surgeon specializing in sports medicine, shoulder, knee and elbow surgery

Web page: www.MyOrthoDoc.com

I focus on injuries related to combat sports. For appointments please call 714 639-3750

Follow me on Twitter: @myorthodoc

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