Pectoralis Major Rupture

with Rehab

ExitCare ImageThe pectoralis major is the main muscle of the chest. It is responsible for bringing the arm across the body and for rotating the arm inward. A pectoralis major rupture is a tear in the tendon that attaches the chest muscle to the upper arm bone (humerus). When the tendon is torn, there is a loss of connection between the muscle and the bone. Pectoralis major ruptures usually involve the tendon pulling off from the arm bone, although sometimes the muscle may tear in the mid-belly or at the point where the muscle becomes tendon.

SYMPTOMS

  • A "pop" or tearing, and severe sharp, often burning, pain in the chest at the time of injury.

  • Tenderness, swelling, warmth, or redness and later bruising (contusion) over and around the pectoralis muscle-tendon, chest, and armpit region.

  • Pain and weakness when trying to use the chest muscle.

  • Loss of shape of the armpit region, especially when pushing your hands together in front of your body.

  • Loss of firm fullness, when pushing on the area where the tendon ruptured (a defect between the ends of the tendon and bone where they separated from each other).

CAUSES

The pectoralis major muscle or tendon tears when a force is placed on it that is greater than it can handle. Common causes of injury include:

  • Sudden episode of stressful over-activity.

  • Direct hit (trauma) to the chest.

  • Fall from a height.

RISK INCREASES WITH:

  • Sports that require excessive muscle stress, (weightlifting).

  • Contact sports with minimal protective devices for the chest.

  • Wrestling.

  • Poor strength and flexibility.

  • Previous injury to the chest muscle.

  • Untreated pectoralis major tendinitis.

  • Corticosteroid injection into the pectoralis major tendon. (Corticosteroid injections damage tendons.)

  • Oral anabolic steroid use.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow for adequate recovery between workouts.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

PROGNOSIS

If treated properly, pectoralis major ruptures are usually curable, with a return to sports in 6 to 9 months.

RELATED COMPLICATIONS

  • Weakness of the pectoralis major, especially if left untreated.

  • Re-rupture of the tendon after treatment.

  • Prolonged disability.

  • Risks of surgery: infection, injury to nerves (numbness, weakness, or paralysis), bleeding, hematoma (blood clot), pseudocyst (collection of fluid), shoulder stiffness, shoulder weakness, and pain with strenuous activity.

  • Loss of chest or armpit shape.

  • Inability to repair rupture.

TREATMENT

Treatment first involves resting from any activities that aggravate the symptoms. The use of ice and medicine will help reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home. However, referral to a therapist may be advised for further evaluation and treatment, such as ultrasound therapy. If the rupture occurs in the muscle or the muscle-tendon juncture, surgery repair is not possible. However, for tears that occur at the attachment site of the arm bone, surgery may be advised. Without surgery, the loss of normal armpit shape and weakness of the shoulder will persist. For the best chance of a successful outcome, surgery must be performed within the first few weeks after injury. After surgery, the chest and shoulder of the affected side are restrained, to allow for healing. After restraint, it is important to perform strengthening and stretching exercises to help regain strength and a full range of motion.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given, if your caregiver thinks they are needed. Use only as directed and only as much as you need.

COLD THERAPY

Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK MEDICAL CARE IF:

  • Pain increases, despite treatment.

  • Any of the following occur after surgery: signs of infection, including fever, increased pain, swelling, redness, drainage of fluids, or bleeding in the affected area.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Pectoralis Major Rupture

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image ROM - Pendulum

  • Bend at the waist so that your right / left arm falls away from your body. Support yourself with your opposite hand on a solid surface, such as a table or a countertop.

  • Your right / left arm should be perpendicular to the ground. If it is not perpendicular, you need to lean over farther. Relax the muscles in your right / left arm and shoulder as much as possible.

  • Gently sway your hips and trunk so they move your right / left arm without any use of your right / left shoulder muscles.

  • Progress your movements so that your right / left arm moves side to side, then forward and backward, and finally, both clockwise and counterclockwise.

  • Complete __________ repetitions in each direction. Many people use this exercise to relieve discomfort in their shoulder, as well as to gain range of motion.

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

ExitCare Image STRETCH – Flexion, Standing

  • Stand with good posture. With an underhand grip on your right / left and an overhand grip on the opposite hand, grasp a broomstick or cane so that your hands are a little more than shoulder width apart.

  • Keeping your right / left elbow straight and shoulder muscles relaxed, push the stick with your opposite hand to raise your right / left arm in front of your body and then overhead. Raise your arm until you feel a stretch in your right / left shoulder, but before you have increased shoulder pain.

  • Try to avoid shrugging your right / left shoulder as your arm rises, by keeping your shoulder blade tucked down and toward your mid-back spine. Hold __________ seconds.

  • Slowly return to the starting position.

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

ExitCare Image STRETCH – Abduction, Supine

  • Lie on your back. With an underhand grip on your right / left hand and an overhand grip on the opposite hand, grasp a broomstick or cane so that your hands are a little more than shoulder width apart.

  • Keeping your right / left elbow straight and shoulder muscles relaxed, push the stick with your opposite hand to raise your right / left arm out to the side of your body and then overhead. Raise your arm until you feel a stretch in your right / left shoulder, but before you have increased shoulder pain.

  • Try to avoid shrugging your right / left shoulder as your arm rises, by keeping your shoulder blade tucked down and toward your mid-back spine. Hold __________ seconds.

  • Slowly return to the starting position.

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

ExitCare Image ROM – Flexion, Active-Assisted

  • Lie on your back. You may bend your knees for comfort.

  • Grasp a broomstick or cane so your hands are about shoulder width apart. Your right / left hand should grip the end of the stick, so that your hand is positioned "thumbs-up," as if you were about to shake hands.

  • Using your healthy arm to lead, raise your right / left arm overhead until you feel a gentle stretch in your shoulder. Hold __________ seconds.

  • Use the stick to assist in returning your right / left arm to its starting position.

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

ExitCare Image STRETCH - External Rotation and Abductio

  • Stagger your stance through a doorframe. It does not matter which foot is forward.

  • Choose one of the following positions as instructed by your physician, physical therapist or athletic trainer. Place your hands:

  • and forearms above your head and on the door frame.

  • and forearms at head height and on the door frame.

  • at elbow height and on the door frame.

  • Keeping your head and chest upright and your stomach muscles tight to prevent over-extending your low-back, slowly shift your weight onto your front foot until you feel a stretch across your chest and in the front of your shoulders.

  • Hold __________ seconds. Shift your weight to your back foot to release the stretch.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Pectoralis Major Rupture

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided by your caregiver.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your caregiver.

ExitCare Image STRENGTH - Scapular Protractors, Standing

  • Stand arms length away from a wall. Place your hands on the wall, keeping your elbows straight.

  • Begin by dropping your shoulder blades down and toward your mid-back spine.

  • To strengthen your protractors, keep your shoulder blades down, but slide them forward on your rib cage. It will feel as if you are lifting the back of your rib cage away from the wall. This is a subtle motion and can be challenging to complete. Ask your caregiver for further instruction, if you are not sure you are doing the exercise correctly.

  • Hold for __________ seconds. Slowly return to the starting position, resting the muscles completely before starting the next repetition.

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

ExitCare Image STRENGTH - Horizontal Abductors

Choose one of the two positions to complete this exercise.

Prone: lying on stomach:

  • Lie on your stomach on a firm surface so that your right / left arm overhangs the edge. Rest your forehead on your opposite forearm. With your palm facing the floor and your elbow straight, hold a __________ weight in your hand.

  • Squeeze your right / left shoulder blade to your mid-back spine and then slowly raise your arm to the height of the bed.

  • Hold for __________ seconds. Slowly reverse the directions and return to the starting position, controlling the weight as you lower your arm.

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

Standing:

  • Secure a rubber exercise band or tubing to a fixed object (table, pole) so that it is at the height of your shoulders when you are either standing, or sitting on a firm armless chair.

  • Grasp an end of the band in each hand and have your palms face each other. Straighten your elbows and lift your hands straight in front of you at shoulder height. Step back away from the secured end of band until it becomes tense.

  • Squeeze your shoulder blades together. Keeping your elbows locked and your hands at shoulder height, bring your hands out to your sides.

  • Hold __________ seconds. Slowly ease the tension on the band, as you reverse the directions and return to the starting position.

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

ExitCare Image STRENGTH - Scapular Protractors, Quadruped

  • Get onto your hands and knees with your shoulders directly over your hands (or as close as you can comfortably be).

  • Keeping your elbows locked, lift the back of your rib cage up into your shoulder blades so your mid-back rounds out. Keep your neck muscles relaxed.

  • Hold this position for __________ seconds. Slowly return to the starting position and allow your muscles to relax completely before starting the next repetition.

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

ExitCare Image STRENGTH – Scapular Depressors

  • Find a sturdy chair without wheels, such as a dining table chair, and place your hands on the armrests.

  • Keeping your feet on the floor, lift your bottom from the seat and lock your elbows.

  • Keeping your elbows straight, allow gravity to pull your body weight down. Your shoulders will rise toward your ears.

  • Raise your body against gravity by drawing your shoulder blades down your back, shortening the distance between your shoulders and ears. Although your feet should always maintain contact with the floor, your feet should progressively support less body weight as you get stronger.

  • Hold __________ seconds. In a controlled and slow manner, lower your body weight to begin the next repetition.

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

ExitCare Image STRENGTH - Scapular Protractors, Supine

  • Lie on your back on a firm surface. Extend your right / left arm straight into the air while holding a __________ weight in your hand.

  • Keeping your head and back in place, lift your shoulder off the floor.

  • Hold __________ seconds. Slowly return to the starting position and allow your muscles to relax completely before starting the next repetition.

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