Pectoralis Major Rupture

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Pectoralis major tendon rupture is a rare shoulder injury, most commonly seen in weight lifters.  This injury is being seen more regularly due to the increased emphasis on healthy lifestyles.

Clinically Relevant Anatomy

Pectoralis major muscle is a very powerful shoulder muscle during its function – that of shoulder adductor, internal rotator, and flexor of the humerus. Origins of the pectoralis major include the clavicle, sternum, ribs, and external oblique fascia as well as cartilage of the first six ribs.The insertion of the pectoralis tendon onto the humerus occurs with the muscle twisting on itself so that the lowest fibers of the tendon insert at the highest location on the humerus.Wolfe et al have previously demonstrated that this attachment results in significant tension in the inferior portion of the pectoralis muscle and predisposes this portion to rupture when stretched and loaded. Wolfe and collegues measured excursion of individual pectoralis muscle fibers at seven different points along the origin by the use of finewires connected to humeral insertion and to dial gauges.Inferior fibers of the pectoralis major muscle lengthened disproportionately during the final 30 degrees of humeral extension. This attachment arrangement may result inpartial tears being much more common than that of com-plete ruptures.

Mechanism of Injury / Pathological Process

Although pectoralis tendon ruptures are most commonly seen in weight lifting, ruptures have also been reported in many other sporting activities such as boxing, football,rodeo, water skiing, and wrestling.These injuries tend to occur more commonly in patients during their second to fourth decade of life.To date, this rupture is a totally male dominated athletic injury with not even a single case study report of injury to the female athletic population.

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