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Pectoralis Muscle Rupture

The pectoralis muscle insertion at the upper humerus or muscle bulk can rupture partially or completely.

ICD-10-CM Diagnosis Code S29.011A

Sudden onset of localized pain in the anterior part of the shoulder and upper arm after excessive abduction and external rotation such as in a rugby tackle, wrestling and auto accidents.


  • Weightlifting (bench press specifically) is a common mechanism.
  • Direct trauma to muscle in , rugby,  also reported .
  • There is weakness on internal rotation and forward flexion.

Pectoralis is a powerful adductor, internal rotator, and flexor of humerus.

Main source of power to the torso during strenuous activity

Pectoralis Muscle Rupture
Pectoralis Muscle Rupture

It has two heads:

  1. Superior/clavicular: Originates at medial clavicle and upper sternum.
  2. Inferior/sternal: Originates at distal sternum, external oblique fascia, costal cartilage of 1st 6 ribs.

Clinical Findings

  • Swelling and ecchymosis in anterior shoulder/chest most common
  • May have loss of axillary fold accentuated by abduction to 90 degrees
  • Shoulder motion limited by pain
  • Weakness in abduction and internal rotation

 

Differential Diagnosis

  • Long head biceps subluxation
  • Proximal humerus fracture
  • Gleno-humeral dislocation
  • Rotator cuff tear

Treatment

Acute treatment:

  • Analgesics
  • Ice
  • Sling immobilization

 

Long-term care:

  • Tear type, patient age, activity level, and cosmetic desires determine care.
  • Most partial tears, sternoclavicular tears, and muscle belly tears are treated non surgically.
  • Complete sternal tears require surgical repair to restore function and strength
  • Conservative treatment may be enough in elderly/inactive population irrespective of type of tear. 

Exercise Prescription 

  • Most general activities are possible but secondary symptoms due to pain are common and must be addressed. 
  • Running should be avoided initially as the shoulder will be sensitive to this type of movement and holding the arm still while running will cause secondary upper back and neck pain. 
  • Swimming is also hold for around three months. 
  • The specific rehabilitation should aim at a full range of controlled motion, good posture and thoraco-scapular control within three months followed by functional training for up to six months before resuming sports like rugby.