Dear Cyclone Fanatics –
Today I’m going to teach you a bit about a fairly infrequent injury to the shoulder: the pectoralis major tendon rupture. Unfortunately, this injury requires operative repair, followed by months of healing and rehabilitation.
The pectoralis is a very powerful muscle that is the major muscle of the chest. It moves the arm forward and across your chest. It is best known as the muscle that is developed with the bench press and push-ups. The rupture (tear) usually occurs at the tendon as it attaches to the upper humerus (arm bone). It can be a partial injury or muscle strain, but more often involves a significant tear (it can snap just like a rubber band).
Insertion for R pectoralis tendon. 
This injury typically occurs in our lineman (offensive or defensive), or linebackers, and usually happens on the playing field when blocking or tackling and the arm is forced out to the side, or in the weight room when bench pressing. The athlete typically feels a ‘pop,’ along with pain, to the front of the shoulder and then notices weakness and deformity to this area. There is often a palpable defect in the area, which makes one suspicious for a tear.
Notice defect in R pectoral muscle. 
Often, MRI is used to confirm the diagnosis.
SURGICAL TECHNIQUE
Surgical repair involves attaching the tendon directly back to the upper arm bone insertion, allowing the body to heal with “normal anatomy”. This restores the power and motion of the musculotendinous unit (somewhat akin to restoring the power of a pulley). 
Left pec tendon tear.Suture in place. Repaired to bone.
SURGERY IS INDICATED
The medical literature explains that patients who undergo surgical repair have a significantly higher rate of return to pre-injury strength and return to sporting activities, as well as less pain, than patients managed conservatively. Outcome studies show that repaired injuries regained 97% of the strength of the uninjured arm (vs. 56% in non-operative patients), so it is necessary for an elite athlete to undergo operative repair to optimize recovery and return to competition.
The earlier a repair is performed the easier the surgery is from a technical standpoint, and the better the outcome of surgery. Outcomes after early primary repair have generally been superior to those of delayed repair. When surgery is delayed for weeks or months, the risk of failure and complications increases as a result of significant retraction of the tendon and scarring of the muscle. This shows the importance of correct diagnosis.
Post-operatively there is immobilization during the healing phase and then rehabilitation to gradually restore motion and strength. This can be a long and arduous process, and can take many months for ultimate recovery and return to play.
Hopefully pectoralis tears will be a rare injury for our Cyclones (as well as for our Fanatics), but if such an injury occurs don’t hesitate to call us at McFarland Clinic Orthopedic Sports Medicine Department (515-239-4475).
Now let’s think “stay healthy” for the Cyclones as they head down to Austin, looking for a Win!
Go State, Thomas Greenwald, MD
Dr Greenwald can be reached at thomasgreenwaldmd.com. Follow him on twitter at @orthodoc_tg.
