Chronic Pectoralis Major Tendon Tears
Steve Mora MD
Orange County Shoulder Specialist
Chronic tears of the pectoralis major tendon present a unique problem for both the patient and the surgeon. Most chronic tears require a cadaver graft to bridge the gap between the torn stump and the bone. Because of the complex nature of this surgery many surgeons will recommend that patients accept the problem as it is and to live with the effects. A chronically torn tendon leads to push off weakness and a significant chest wall deformity. Most young athletic patients have a hard time accepting the profound weakness; specially if there may be a potential solution. In cases of complete tears the solution is going to require surgery. Small partial tears will probably be okay without surgery. It is also not rare for these injuries to be mis diagnosed. By the time the diagnosis is made, a simple repair may not be possible. Presented in the video below is a case of a complete tear in a high level athlete which I recently performed. I discuss the surgery in detail.
Video: Dr Mora discusses surgical repair of a chronic Pectoralis Major Tendon rupture.
The case I discussed above was very interesting because I was able to do a primary repair (no graft) on a complete tear that occurred 2 years prior to surgery. I was expecting to use a cadaver graft to bridge the gap. The tear was not only causing weakness but also a disfiguring deformity of the chest wall.
The surgery was done as outpatient; the patient went home the same day. The anesthetic was general along with a nerve block. A 4 inch incision is made over the anterior shoulder. The tendon stump was identified, freed up, grasped and pulled towards the proximal humerus. The scar tissue was gingerly released from above and below the muscle. The stump was tagged with 3 very heavy non absorbable sutures which were secured to 3 small rice sized metal anchors. These anchors were then passed into the proximal humerus bone through 3 small drill holes. In this case I was able to do a primary repair on a very old tear. This is usually not the situation.
If the tendon could not have been brought back to bone, I would have used a cadaver tendon graft, a.k.a. allograft, to bridge the space between the torn stump and the bone. The cadaver graft is “acellular” therefore the risk of rejection is slim to none.
After surgery patients will use an arm sling for 6 weeks. The arm can be taken out of the sling for very gentle movements. After 6 weeks patients are started on light strengthening exercises. Heavier training is done after 3 months. Full contact and sports are done after 6 months.
Chronic pectoralis major tendon tears present a unique problem for both the patient and the surgeon. These tears are frequently seen in weightlifters and in combat sports. The patient looses strength and develops a chest wall deformity. The surgeon has to deal with a technically difficult problem. Patients have to deal with a long recovery before being able to fully test out the repair. Tears that have been present for more than 4-6 weeks shrink and usually become non repairable. What that means is that the torn pectoralis major tendon stump cannot be pulled back to the upper arm bone. When operating on chronic tears the surgeon has to be prepared to use a cadaver graft to bridge the torn stump back to bone. When the tear is fresh it can easily be pulled and reattached to the upper arm bone. Using a cadaver graft is technically challenging. Some surgeons prefer to refer these chronic repairs to surgeons with more experience. Some surgeons will also unfortunately tell the patient that they have to live with the problem. In my experience these tears can be repaired either primarily such as the patient presented in the video or with a graft. Early repair of a pectoralis major tendon is the best case scenario. Patients who require the use of a cadaver graft do not do as well but are better than if the tear was not repaired. Patients with a successful repair will usually resume all activities within six months or a bit sooner.
I hope this information helped. Please let me know if I can be of service.
Here’s a review from one of my patients who underwent surgery for their pec rupture.
About Steve A. Mora MD:
Dr. Mora is a native of Orange County. He graduated from Anaheim High School in Orange County CA. He received his medical education at UC Irvine College of Medicine where he finished at the top of his class earning the coveted AOA Medical Society honors. He completed his Orthopedic Surgery training LAC+USC Medical Center and then conpleted a Sports Medicine Fellowship where he focused on sports medicine, shoulder, knee, hip arthroscopy. He has published numerous book chapters on the topics of ACL injuries in soccer players, cartilage restoration, and athletic hip injuries. He is currently practicing Orthopedic Surgery in the City of Orange Orange County. He is a founding partner at Restore Orthopedics and Spine Center (www.restoreorthopedics.com). Dr. Mora’s practice focus is on sports related trauma, MMA injury treatment, arthroscopy of the shoulder, hip, knee and elbow, and partial and total knee replacement. He sees athletes of all levels including professional soccer and UFC/MMA patients. Dr. Mora’s family heritage is Peruvian. He speaks fluent Spanish.
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Restore Orthopedics and Spine Center
112o W. La Veta Ave, Third Floor
Orange, CA 92868
Office: (714) 332-5498