Injuries and conditions

Pectoralis Major Rupture

Pectoralis Major Rupture

Pectoralis major ruptures typically occur in men between the ages of 20-40. They are most often caused by sudden eccentric force. If enough of the tendon pulls away then surgery may be required to bring the tendon back to its normal insertion point on the humerus.

This is an uncommon acute injury caused by avulsion of the pectoralis major tendon (from the humeral insertion on the arm) and is commonly seen in weightlifters. The tendon may rupture off the bone, through the tendon body or at the muscle-tendon junction. The sternocostal head of the pectoralis major tenon is the most common site of rupture.

These tears almost exclusively occur in males and are frequently seen in weightlifters. Anabolic steroid use is a recognised risk factor for tendon rupture.

Medical diagram showing a Pectoralis major tendon rupture

Diagnosis is generally made on history and examination; and is confirmed with an MRI scan. 

Patients may report a sudden pop or tearing sensation with resisted adduction and internal rotation. This leads to pain and weakness of the shoulder. 

Examination will show swelling and bruising over the chest wall and upper arm. The “dropped nipple” sign is classic for a pectoralis major tendon rupture – the affected nipple sits lower than the unaffected side. There may be a palpable defect and loss of anterior axillary (armpit) contour. There is often pronounced weakness in adduction and internal rotation. 

Imagingplain X-rays are often normal. An MRI scan is the most useful test and can locate the tear, assess retraction and define whether the tear is partial thickness or full thickness. Generally, full-thickness tears can be diagnosed clinically and partial thickness tears will be seen on MRI.

Photo of upper right arm showing the classic bruising pattern after a pectoralis major tendon rupture

Non-surgical treatment

  • Ideal for low-grade partial and muscle belly tears
  • Elderly, low demand and sedentary patients with other medical issues

Surgical treatment

  • Gold standard for acute tears in high-level athletes, active patients and younger sportspersons
  • Ideal for tendon avulsion and myotendinous junction tears

Surgery is the preferred option for those with full thickness acute tears that want a reliable outcome with restoration of function. The outcomes after surgery are reliable in strength recovery, return to sport, and patient satisfaction.

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