Pectoralis Major Rupture

Injuries to the pectoralis major muscle range in severity from mild strains and contusions to complete ruptures. Careful physical examination and a high level of suspicion based on history are keys to accurate and timely diagnosis. Injuries are most common in males in the 20s and 30s and occur when load is applied to an eccentrically contracting muscle. In the pectoralis major, this situation frequently occurs when the arm is maximally loaded in a position of forward flexion, abduction, and external rotation. Injuries are classified based on tear location and severity. Physical examination of an acute rupture typically reveals significant bruising of the chest, axilla, and arm, along with loss of the axillary fold. The diagnosis can be confirmed with ultrasound or MRI. While contusions and partial tears can often be managed nonoperatively, complete ruptures near the distal insertion are generally treated surgically. A variety of repair techniques have been described.