What is Pectoralis Major Rupture

Pectoralis major rupture is a tear (rupture) in one of the muscles in the chest (pectoralis major). There are two of these muscles in the chest, one on each side.

The pectoralis major muscles help to straighten the arms and push forward. A pectoralis major rupture often tears the muscle away from bone along the breastbone, collarbone, or upper arm. This injury causes pain and weakness in the chest and shoulder.

What are the causes?

This condition is caused by putting too much stress on the pectoralis major muscle. This is most commonly a result of weight lifting.

What increases the risk?

This condition is more likely to develop in men, especially men who use anabolic steroids. This condition is also more likely to develop in people who participate in any of the following activities:

• Weight lifting.
• Rugby.
• Football.
• Gymnastics.
• Skiing.
• Wrestling.
• Boxing.
• Hockey.

What are the signs or symptoms?

At the time of the rupture, you may hear a pop and feel a tearing pain. Other signs and symptoms may include:

• Swelling.
• Bruising.
• Weakness.
• A bulge or abnormality in the muscle (deformity).
• Pain and tenderness when pressing on the muscle.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms.
• Your medical history.
• A physical exam. Your health care provider may:
  • Compare one side of your chest to the other.
  • Check for weakness, bruising, and tenderness.
• Imaging tests to find the exact location of the rupture and check how severe it is. Tests may include:
  • MRI.
  • Ultrasound.

How is this treated?

In young, active people and athletes, this condition is usually treated with surgery to reattach the muscle and repair the rupture. If your rupture is minor, or if you are older, you may not need surgery.

Non-surgical treatment may include:

• Wearing a sling for 3–6 weeks to keep your arm still (immobilization).
• NSAIDs to help relieve pain and swelling.
• Physical therapy to improve your range of motion and strength.

Follow these instructions at home:

If you have a sling:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the sling if your fingers tingle, become numb, or turn cold and blue.
• Do not let your sling get wet if it is not waterproof.
• Keep the sling clean.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• If your sling is not waterproof, cover it with a watertight covering when you take a bath or a shower.

Managing pain, stiffness, and swelling

• If directed, apply ice to your injured area.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your fingers often to avoid stiffness and to lessen swelling.

Driving

• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe to drive if you have a sling on your arm.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Do not use anabolic steroids.
• If you start a weight lifting program, make sure that you have supervision. As your fitness improves, you may add weight gradually.
• Warm up and stretch before being active.
• Cool down and stretch after being active.
• Give your body time to rest between periods of activity.
• Make sure to use equipment that fits you.
• Be safe and responsible while being active to avoid falls.
• Maintain physical fitness, including:
  • Strength.
  • Flexibility.
  • Endurance.

Contact a health care provider if:

• You continue to have pain, swelling, or weakness after 4 weeks.
• Exercising makes your symptoms worse.

Pectoralis Major Rupture Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your shoulder. These exercises can also help to relieve pain, numbness, and tingling.

Exercise A: Pendulum

1. Stand near a wall or a surface that you can hold onto for balance.
2. Bend at the waist and let your left / right arm hang straight down. Use your other arm to keep your balance.
3. Relax your arm and shoulder muscles, and move your hips and your trunk so your left / right arm swings freely. Your arm should swing because of the motion of your body, not because you are using your arm or shoulder muscles.
4. Keep moving so your arm swings in the following directions, as told by your health care provider:
   1. Side to side.
   1. Forward and backward.
   1. In clockwise and counterclockwise circles.
5. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Abduction, standing

1. Stand and hold a broomstick, a cane, or a similar object. Place your hands a little more than shoulder-width apart on the object. Your left / right hand should be palm-up, and your other hand should be palm-down.
2. While keeping your elbow straight and your shoulder muscles relaxed, push the stick across your body toward your left / right side. Raise your left / right arm to the side of your body and then over your head until you feel a stretch in your shoulder.
   1. Stop when you reach the angle that is recommended by your health care provider.
   1. Avoid shrugging your shoulder while you raise your arm. Keep your shoulder blade tucked down toward the middle of your spine.
3. Hold for __________ seconds.
4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Wand flexion, supine

1. Lie on your back. You may bend your knees for comfort.
2. Hold a broomstick, a cane, or a similar object so that your hands are about shoulder-width apart on the object. Your palms should face toward your feet.
3. Raise your left / right arm in front of your face, then behind your head (toward the floor). Use your other hand to help you do this. Stop when you feel a gentle stretch in your shoulder, or when you reach the angle that is recommended by your health care provider.
4. Hold for __________ seconds.
5. Use the broomstick and your other arm to help you return your left / right arm to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Wand shoulder external rotation

1. Stand and hold a broomstick, a cane, or a similar object so your hands are about shoulder-width apart on the object.
2. Start with your arms hanging down, then bend both elbows to an “L” shape (90 degrees).
3. Keep your left / right elbow at your side. Use your other hand to push the stick so your left / right forearm moves away from your body, out to your side.
   1. Keep your left / right elbow bent to 90 degrees and keep it against your side.
   1. Stop when you feel a gentle stretch in your shoulder, or when you reach the angle recommended by your health care provider.
4. Hold for __________ seconds.
5. Use the stick to help you return your left / right arm to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your shoulder. Endurance is the ability to use your muscles for a long time, even after your muscles get tired.

Exercise E: Scapular protraction, standing

1. Stand so you are facing a wall. Place your feet about one arm-length away from the wall.
2. Place your hands on the wall and straighten your elbows.
3. Keep your hands on the wall as you push your upper back away from the wall. You should feel your shoulder blades sliding forward. Keep your elbows and your head still.
   1. If you are not sure that you are doing this exercise correctly, ask your health care provider for more instructions.
4. Hold for __________ seconds.
5. Slowly return to the starting position. Let your muscles relax completely before you repeat this exercise.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise F: Shoulder blade squeezes (scapular retraction)

1. Sit with good posture in a stable chair. Do not let your back touch the back of the chair.
2. Your arms should be at your sides with your elbows bent. You may rest your forearms on a pillow if that is more comfortable.
3. Squeeze your shoulder blades together. Bring them down and back.
   1. Keep your shoulders level.
   1. Do not lift your shoulders up toward your ears.
4. Hold for __________ seconds.
5. Return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.