Pectoralis Major Tear Treatment in Adelaide
Dr Arthur Turow, Shoulder SurgeonA pectoralis major tear, often called a torn pec, can cause sudden pain, bruising and change the shape of the front of your shoulder. It may happen during bench pressing, a footy tackle or another forceful movement. Dr Arthur Turow assesses and treats pectoralis major injuries in Adelaide; helping you understand the tear and whether rehab or surgical repair is recommended.
Pectoralis major tendon tear at its attachment to the upper arm bone
A pec tear injures the muscle that helps you push & move your arm across your body
A sudden pop, bruising, weakness or a change in your chest shape can indicate a tear
A pec tendon tear needs prompt assessment
Some tears can be treated with physio, while others benefit from surgical repair
Treatment depends on where the tear is, how much is torn & your demands for work or sport
Recovery after a repair involves a sling for 6 weeks & rehab. Returning to demanding sport often takes around 6+ months
What is a pectoralis major tear?
The pectoralis major is a large muscle at the front of your chest and shoulder. Its tendon attaches to the upper arm bone, helping you push forward, bring your arm across your body & rotate your arm inwards.
The leading edge of the muscle gives you the shape of your anterior shoulder. A tear can affect how your shoulder and chest look. A tear can occur within the muscle, where the muscle joins the tendon, or where the tendon attaches to the bone. It may involve part or all of the muscle. The location and size of the tear are important when deciding on treatment.
What causes a torn pec?
Pectoralis major tears often happen when the muscle is stretched against resistance or a heavy load. A common example is lowering the bar during a bench press.
Tears can also occur during sports, such as footy, rugby and other team sports that place a sudden load through the chest and shoulder.
Symptoms of a pectoralis major tear
The most common presentation of a pec major tear is a sudden pop that is felt at the front of the shoulder with pain, swelling and bruising. Partial tears may be less obvious. Your shoulder movement is usually preserved, so a thorough assessment is important after an injury. Symptoms generally include:
- A sudden popping or tearing sensation
- Pain at the front of the chest, shoulder or armpit
- Bruising at the front of the chest that spreads down your arm or chest
- Weakness when pushing forward or bringing your arm towards you
- A change in chest shape or change in the normal fold at the front of your armpit
With a pec tear, you may notice a change in contour of your chest when pressing your hands into your hips. Arrow showing a torn pec
Pectoralis Major
The pectoralis major is a large muscle of the anterior chest. It gives shape to the anterior contour of your shoulder.
Pec Major Tear
Tearing of the pectoralis major can lead to bruising, swelling and loss of the contour of your anterior shoulder.
Pec Major Repair
Repair of pectoralis major tear involves re-attaching the tendon back to its original footprint.
When should you get a suspected pec tear assessed?
You should get your shoulder assessed if you had an injury where you either felt a sudden pop or tearing in your shoulder. Bruising, weakness and chest contour deformity are also an indication of a pec major tear.
Some tendon tears benefit from surgical repair. Identifying the injury early allows you to discuss your options. With time your tear will undergo scarring and tendon retraction, making treatment more tricky.
An injury that you sustained a while ago can still be assessed. Treatment depends on the type and size of the tear as well as your symptoms.
How is a pectoralis major tear diagnosed?
Assessment starts with how your injury happened, followed by examination of your shoulder, movement and strength.
An ultrasound can help to identify the tear and distinguish it from other injuries, such as proximal biceps tendon tear. An MRI may be needed to identify the location and the size of the tear.
Dr Turow will advise which imaging is best for you.
Treatment for a pectoralis major tear
Treatment depends on the tear pattern, how recently it occurred, your symptoms and the demands of your work, sports or other activities you like doing.
Treatment without surgery
Some pec injuries, for example partial tears, can be managed without surgery. This involves a period of protection in a sling, pain relief and physio. This is then followed by a gradual return to normal activity.
Non-surgical treatment may also be appropriate when the expected benefits of surgery do not outweigh its risks. A substantial tendon tear can leave ongoing weakness or a change in chest shape, even after the pain improves.
Pectoralis major tendon repair
Surgery is often recommended for a complete tendon tear in an active person. Some partial tears may also warrant a repair if they cause significant weakness or functional limitations. Surgery aims to reattach the torn muscle and tendon back to its anatomical insertion point on the upper arm. Older tears can be more difficult to repair because of scarring and tendon retraction. A tendon graft may be needed if the tissue cannot be repaired directly.
The aim is to improve your strength, function and restore your chest contour. Risks include infection, stiffness, persistent weakness and failure of the repair. Dr Turow will explain the benefits and risks of surgery for your particular injury with you.
Recovery after pectoralis major tendon repair
Recovery after a pec repair follows a staged physio program. The first six weeks focus on protecting the repair. Movement follows. Resistance exercises are introduced from 12 weeks. Returning to contact sport or heavy chest training is usually considered from six months, depending on your progress.
The following is a guide for an uncomplicated tendon repair.
Stage 1: Protecting your Repair (0 to 6 Weeks)
- In the first six weeks the repair needs to be protected
- You can start on some early range of motion from two weeks
- You will need to wear a sling during this time
- Avoid lifting, pushing or supporting your body weight through the operated arm
Stage 2: Increase Range of Motion (6 to 12 Weeks)
- The sling is gradually weaned
- Shoulder movement and stretching are gradually increased with your physio
- Exercises focus on movement while protecting your tendon repair
- Heavy lifting and resisted pec loading remain restricted until about 12 weeks
Stage 3: Light loading (12 to 16 Weeks)
- Begin light resistance exercises
- Pec loading and range are gradually increased
Stage 4: Strengthening (4 to 6 Months)
- The next two months focus on strengthening, endurance and exercises that are important for your sport
- You can return to swimming
- You should still avoid heavy chest fly exercises, maximal lifts & contact sport
Stage 5: Return to full activities (6+ Months)
- From six months onwards you can generally return to full activities
- Increase activity gradually after review with Dr Turow & your physio.
- Returning to your previous training level may take longer.
Pectoralis major tear assessment in Adelaide
Dr Arthur Turow is an Australian-trained orthopaedic surgeon whose practice focuses on shoulder and upper limb conditions. His qualifications include FRACS (Orth) and FAOrthA. He holds staff specialist appointments at the Royal Adelaide Hospital and The Queen Elizabeth Hospital. He also holds a Master of Surgery and is a clinical lecturer with the University of Adelaide.
Your consultation will consider your injury and what your shoulder needs are. Dr Turow will discuss with you non-surgical and surgical options; including whether a repair is needed and how treatment would affect your work, sports and everyday activities.
Consultations are available in Adelaide CBD and at regional locations across South Australia, including Yorke Peninsula, Gawler and Mt Barker.
Book an appointment or call (08) 8236 4179.
Frequently Asked Questions
What is a pec injury in football?
A pec injury affects the pectoralis major muscle or tendon at the front of your chest. It can happen during a tackle or when your arm is suddenly forced outwards. Injuries range from muscle strains to tendon tears. Assessment is important if you develop bruising, weakness or a change in chest shape after a football injury.
Can a partial pec tear heal without surgery?
Some partial tears improve with immobilisation & rehab; however, “partial” does not always mean minor. The location of the tear and the amount of weakness matter. A partial tendon tear that substantially affects your function may still benefit from surgery.
Can an old pectoralis major tear still be repaired?
Sometimes. Scarring, tendon retraction and tissue quality all affect the repair and can make treatment more complex. A tendon reconstruction may be needed instead of a direct repair.
When can I bench press after pec repair?
Bench pressing places substantial load on your pec major and on your repaired tendon. You should only restart when your shoulder went through dedicated rehab and started to feel near-normal. Your physio can guide you with this. Generally, returning to heavy bench pressing takes 6+ months, but your previous maximum weight is not an automatic six-month milestone. You will need to build up to your previous lifting limits.
Further Reading
Interested in more scientific information? Below resources explain pec major tear rehab further: