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Pectoral Tear

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Introduction

Pectoralis major is a powerful muscle which makes up the majority of what people consider the chest. The Pectoralis major originates from the sternum (breast bone) and clavicle (collar bone) – subsequently having both sternal and calvicular fibres, and attaches to the front & inner region of the humerus (upper arm bone); it’s action is to take the arm across the body and internally rotate the shoulder.

 

Rarely an avulsion (separation) injury occurs at the arm bone (humerus) where the muscle is attached. This type of injury has become more common as participation in power sports has increased. In the vast majority of cases, the muscle tears from the humerus, however, in rare scenarios, a tear can occur at the sternum.

Signs & Symptoms

  • Usually when performing an exercise/activity with maximal effort.
  • A ‘ripping’ sensation in the shoulder, usually accompanied with an audible ‘snap’ or ‘pop’.
  • Subsequent shoulder and chest pain, weakness & reduced function.
  • Swelling and bruising mostly inside of the arm and lateral chest.
  • Uneven chest muscle bulk – deformity from the muscle ‘bundling’ towards the sternum.

Causes

The highest incidence of this injury is in weight lifting, where the muscle is exposed to considerable force and tension. Pectoral tear has also been recognised in many sports including boxing, water skiing, wrestling and other contact sports – all of which involve extensive force being placed through the muscle at high velocity (Manske & Prohaska, 2007).

 

Pectoralis major injury have shown to be more common in active populations from adolescence and early adulthood. The injury also has a considerably higher incidence in male to the point where little to no cases are known or have been reported in athletic females.

Assessment & Diagnosis

The cause of the injury is important as understanding the mechanism can help your Physiotherapist with diagnosis. Your Physio will take a detailed history followed by a comprehensive physical assessment, focusing on your shoulder function and carrying out special tests to examine specific structures; all of which will aid accurate diagnosis.

 

In some cases, your GP or Physiotherapist may sent you for an MRI scan if they are unable to produce an accurate diagnosis. They may also sent you to an Orthopaedic surgeon for a surgical consideration if the injury is acute.

Self-Management

Initial management will comprise of addressing the pain, swelling and inflammation, especially in the early stages. The ‘PEACE & LOVE’ protocol can be used to support healing in soft tissue injuries (Dubois & Esculier, 2020). The ‘PEACE’ acronym for acute management refers to protect – unload and reduce movement for 1-3 days, elevate – to promote fluid transport, avoid – the use of anti-inflammatories initially, compress – to reduce swelling, and educate – having the correct advice on management. As symptoms settle, the ‘LOVE’ element can be implemented which refers to load – optimal loading without exacerbating symptoms, optimism – remain positive and consistent with the advice given, vascularisation – maintain cardiovascular fitness to support blood flow, and exercises – to support return to function and improving strength.

 

Your Physio will educate you on your injury and offer professional recommendations for helping to support your recovery. Having the skills to self-manage will ensure you can achieve optimal outcomes and minimise the likelihood of future complications. Regular re-assessment will measure your progress and make sure you are working towards achieving your rehabilitation goals that will be established collaboratively.

Physiotherapy

Prolonged rehabilitation under to guidance of a Physiotherapist is highly recommended to restore function and support your recovery. The rehabilitation process will be gradual based on healing rates and symptoms. Your Physio can implement hands on treatment techniques to reduce pain, increase range of motion, facilitate healing and help to restore function. Your Physiotherapist will design an individualised home exercise plan and give you the skills and knowledge to manage independently as you advance through your rehab journey.

Escalation of Treatment

Surgery is an option if you want to return to sport, weight lifting or to a strenuous job however this is something that will be discussed with your Physiotherapist before deciding if an onward referral to a Specialist Consultant is suitable.

References

Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE.

 

Manske, R. C., & Prohaska, D. (2007). Pectoralis major tendon repair post surgical rehabilitation. North American journal of sports physical therapy: NAJSPT2(1), 22.

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