Pectoralis major ruptures in sport are on the rise, so what do you need to know?

Mechanism of Injury 

Horizontal extension (62.5%) is the most common mechanism, followed by hyperflexion-abduction (25%) and finally horizontal adduction (12.5%) as displayed in Fig.1

Patho anatomy

The insertion point of the sternocostal head is the most common rupture site.²

Isolated ruptures to the clavicular are extremely rare, as low as 1% in systematic review.³

Equally, ruptures at the muscle origin, muscle belly, and bony avulsions are also very rare.³        

Surgery or Conservative?

The majority of these are treated surgically.³

In Bodendorfer and colleagues systematic review (n=664), operative treatment was significantly superior to nonoperative treatment in the following measures:²

• Functional outcome (+23%)
• Isometric strength (+77%)
• Isokinetic strength (+29%)
• Cosmesis satisfaction (+14%)
• Resting deformity (+99%)

Complication rate for operative treatment was 14% and a re-rupture rate of only 3%.²  

Return to Sport Timelines:

In the literature, the wide range of timelines reflects the limited research regarding return to play:

• AFL: 11 weeks (8-15 weeks)²
• Multi-sport: 6.1 months (+- 1.7 months)³
• NFL: 16 - 21 weeks^5,6

Cullan Ball’s recent Sports MAP Masterclass details an accelerated return to play program with the goal of returning at approximately 12 weeks post-op (Table 1). 

Return to Play Testing

The ASH-Test is recommended to assess an athlete’s ability to contract force quickly through the pectoral / anterior shoulder.

Ben Ashworth in his Sports MAP Masterclass outlined the following goals with the test:

• In the I-position, aim for peak force >2N/BW and a rate of force development (@ 100ms) of >500N/sec
• The Y-Position is 85% and T-position is 75% of total strength when compared to the I-position

For those seeking more...

Watch our Sports MAP Masterclass - Accelerated Return from Pec Major Tendon Ruptures with Cullan Ball

Reference List

1. Bodendorfer BM, McCormick BP, Wang DX, Looney AM, Conroy CM, Fryar CM, Kotler JA, Ferris WJ, Postma WF, Chang ES. Treatment of Pectoralis Major Tendon Tears: A Systematic Review and Meta-analysis of Operative and Nonoperative Treatment. Orthop J Sports Med. 2020 Feb 6;8(2)
2. Schwab L, Warby S, Davis K, Campbell P, Hoy S, Zbeda R, Hoy G. Video Analysis of Pectoralis Major Injuries in Professional Australian Football Players. Orthop J Sports Med. 2022 Aug 24;10(8)
3. Yu J, Zhang C, Horner N, Ayeni OR, Leroux T, Alolabi B, Khan M. Outcomes and Return to Sport After Pectoralis Major Tendon Repair: A Systematic Review. Sports Health. 2019 Mar/Apr;11(2):134-141.
4. Solari F, Burns B. Anatomy, Thorax, Pectoralis Major Major. Updated 2023 Jul 24. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
5. Sahota S, Gibbs DB, Lawton CD, Balderama ES, Chambers CC, Mack CD, Franke K, Nuber GW. Pectoralis Major Injuries in the National Football League. Sports Health. 2020 Mar-Apr;12(2):116-123.
6. Tarity TD, Garrigues GE, Ciccotti MG, Zooker CC, Cohen SB, Frederick RW, Williams GR, DeLuca PF, Dodson CC. Pectoralis major ruptures in professional American football players. Phys Sportsmed. 2014 Sep;42(3):131-5.