Pectoralis Major Tendon Injuries: What You Need to Know

The pectoralis major is the substantial chest muscle responsible for inward rotation as well as pushing and lifting with the arm; an injury to its tendon can be a significant matter. You are most likely to sustain such an injury while weightlifting, the bench press in particular. What begins as a minor strain has the potential to develop into a full tear of the tendon from the bone.

Should there be a sudden pop in the shoulder or chest followed by weakness, bruising or pain, a proper evaluation is warranted. An early diagnosis will allow your care team to determine if rest and rehabilitation will suffice or if surgery is called for to get function back.

Those who find they are having difficulty with their workouts or sports, or with simple acts of pushing and lifting, would do well to be aware of the typical symptoms. Knowing what to look for means you can put together a treatment plan suited to the demands of their activity level and get the necessary care without delay.

Key Points About Pectoralis Major Tendon Tears

What You Should Know:

What Is the Pectoralis Major Tendon?

Situated on the front of the chest, the pectoralis major is a broad muscle. Its function is to drive power in pushing movements while also drawing the arm in and rotating it toward the body.

As the muscle nears the humerus, or upper arm bone, it tapers off into a tendon. A tear in the pectoralis major may occur in the muscle belly itself, at the musculotendinous junction or where the tendon inserts. In fact, you will often see avulsions of the tendon in the vicinity of the humerus.

How These Injuries Usually Happen

A tear of the pectoralis major tendon is frequently the result of some forceful exertion. One need only consider the heavy bench press for a typical example; it is in the lowering part of the movement, with the muscle on a stretch and bearing weight, that such injuries are most common.

Contact sports like football or wrestling are another culprit, as is any activity that puts an abrupt strain on the shoulder and chest. Those who have suffered it will often recount a sharp pain and the distinct feeling of something giving way.

Common Signs and Symptoms

Symptoms can vary depending on whether the injury is a strain, a partial tear, or a full rupture. A complete tear often causes stronger pain and noticeable weakness right away, but some partial injuries may look less dramatic at first.

• A sudden pop or tearing feeling in the chest or shoulder
• Pain in the chest, front of the shoulder, or upper arm
• Swelling and bruising, sometimes spreading down the arm
• Weakness with pushing, lifting, or bringing the arm inward
• A change in the contour of the chest or armpit area
• Tenderness where the tendon normally attaches near the upper arm

Some patients notice one side of the chest looks flatter or uneven compared with the other side. This visible change can suggest the tendon has separated or the muscle is not working the way it should.

Who Is Most at Risk?

These injuries often occur in active adults, especially men between the ages of 20 and 40 who do strength training. Heavy bench pressing is a well-known risk factor, particularly when form breaks down under heavy load.

That said, the injury is not limited to competitive lifters. Anyone who puts a sudden, strong force across the chest and shoulder can develop a pectoralis major tendon tear.

How We Diagnose a Pectoralis Major Tear

A clinician will begin the diagnostic process by hearing your account of the incident and then conducting a thorough physical examination. There he or she is looking for any signs of bruising, tenderness or weakness in the chest muscle, as well as alterations in its shape.

To verify a tear and determine if it is partial or complete, an MRI is the usual course of action; it provides a clear picture of the extent of tissue involvement and the location of the tendon injury. An ultrasound can be of some use in certain circumstances.

When Non-Surgical Treatment May Help

In certain cases, a non-surgical approach is the sensible course of action. This applies to partial tears or damage to the muscle belly, and for those whose occupation or sporting pursuits do not demand maximum strength or heavy lifting. Treatment usually focuses on protecting the area, managing pain, and slowly restoring motion with physical therapy.

• Short period of rest and activity modification
• Sling use when recommended for comfort
• Ice and other pain-control strategies
• Physical therapy to improve motion and rebuild strength

Even when surgery is not needed, evaluation still matters. Some problems that feel like a strain turn out to be a tendon tear, and the treatment plan may change based on what is actually injured.

When Surgery Is More Likely to Be Recommended

In the case of a complete tendon tear, surgery is an option to be weighed. This is particularly so for active individuals looking to put in the work to get their strength back and resume sports or weight training, or those with physically taxing jobs. The intent is to put the tendon back together once it has been separated, provided the circumstances are right.

How one proceeds with treatment will hinge on a number of factors: where and how bad the tear is, when it occurred, and what your objectives are. There is often an advantage to having an evaluation done in short order after the injury; before scar tissue has a chance to form and the tendon retracts, the repair can be more straightforward. The care team is there to put things in perspective and let you know what can be expected.

What Recovery Usually Involves

The extent of the injury and any need for surgery will dictate the course of recovery. You have to be patient with the healing process; after all, the shoulder and chest are inextricably linked in everything from lifting to the more mundane movements of the day.

Rehab is typically a matter of stages. In the beginning, the focus is on protecting whatever repair has been done or giving a tear time to settle. As things progress, the aim is to put strength and motion back into the shoulder so that, with the care team’s input, a return to sports or heavy lifting can be made in good order.

Why Early Care Matters

Treatment is not as straightforward when a diagnosis has been put off. Over time, a torn tendon may retract, and the muscle can lose some of its normal function and look.

Should one experience pain, a deformity in the chest or persistent weakness following an injury from lifting, it is unwise to think the matter will resolve on its own. An early and proper diagnosis is the best way to safeguard shoulder function and strength for the long term.

When to See an Orthopaedic Specialist

You should schedule an evaluation if you had a sudden chest or shoulder injury and now have pain, bruising, weakness, or a change in chest shape. This is especially important if the injury happened during weightlifting or contact sports.

• You heard or felt a pop during exercise
• Your chest or upper arm bruised quickly after the injury
• You have lost strength with pressing or pushing
• One side of your chest looks different than the other
• You are having trouble returning to work, sports, or lifting

The team at Princeton Orthopaedic Associates is here to evaluate the injury and, where necessary, look over any imaging. We will then have a conversation about what course of action befits your objectives, be it non-surgical or a repair. For those with concerns over a chest tendon tear, an exam is in order to put together a definitive plan of action; do not hesitate to make an appointment.

Are you suffering from pain?

Please contact us! We'd love to help.

If you have pain, please contact us and schedule an appointment. We have urgent care facilities all over New Jersey for your convenience.

Schedule Exam

Urgent Care

This blog post is meant to be informative and should not act as a self-diagnosis tool. If you’d like to see one of our doctors, please contact us here.