Pectoralis major injury

An Overview

Injuries of the pectoralis major muscle are rare
Although the injury typically occurs while lifting weights, specifically while performing a bench press, it has also been known to occur in several other sports
Several factors, including delay in care and recognition of the injury, can delay appropriate treatment and result in worse outcomes for the patient
Specific treatment of this injury depends on the severity of the injury, the patient’s activity level, and daily living needs

ANATOMY/ The Muscle

There are 2 pectoralis muscles, the pectoralis major and the pectoralis minor (the larger and smaller muscles of the chest)
The pectoralis major is a thick, fan-shaped muscle consisting of 2 heads or portions, the clavicular and the sternal head.
It initiates a wide range of actions on the arm, enabling it to adduct (draw toward the body), flex (bend), extend (straighten), and internally rotate (turn toward the body)

Injury

Pectoralis major injuries can be:

Contusions (bruises)
Inflammation
Complete tears
Damage may occur where the tendon of the pectoralis major joins the upper arm bone or where the muscle joins the tendon
The muscle itself may also rupture or may on rare occasions tear off the sternum

These injuries result in pain, weakness, deformity in the contour of the chest, and, ultimately, a decline in overall shoulder function.

Causes

It is usually caused by activities that involve a large amount of force, such as bench press exercises during weightlifting
It can also occur in other high impact sports such as wrestling, rugby or American football, as well as severe trauma and accidents

Symptoms

In case of a muscle rupture a tearing sensation in the chest may be experienced and a popping sound may be heard
There will be a sudden severe pain and the person may no longer be able to support any heavy weight
He/she may also have pain in the upper arms as well as weakness and bruising
A deformity may be noticed with a lump in the armpit or chest caused by bunching of the pectoralis muscle
The pain is localized to the chest and front of the shoulder or armpit, but may radiate into the upper arm or neck and may increase from an ache to a sharper pain with activity

Diagnosis

Physical Examination

The doctor will carry out a physical examination and ask how the injury occurred

Imaging Tests

X-rays to rule out other problems that can cause shoulder pain
Magnetic resonance imaging (MRI)- An MRI scan is used to determine the location and extent of the tear, including whether it is a partial or complete tear and whether it is mainly in the tendon, or the muscle itself

However, MRI scans must be ordered of the specific pectoralis area. A typical “shoulder” MRI will not image the pectoralis and the exam may be read as “normal”, giving a false negative for the test.Proper MRI imaging is essential for pectoralis evaluation