Pectoralis major ruptures

Injuries of pectoralis major (PM) muscle are among rare muscle injuries. Due to the lack of experience and knowledge in this field, they are often missed or improperly treated. Most often they are caused by an indirect mechanism, during strength sports, typically using the bench press. In clinical terms, they are typically characterized by specific disorder of the anterior axillary fold and a hematoma and, after subsidence of the swelling, disfiguration with medial retraction of the muscle belly. The most beneficial imaging method to examine these injuries is MRI with an emphasis on a properly set protocol. According to the Cordasco classification, they are categorized as PM distensions, isolated and complete ruptures. Ruptures involve most frequently the musculotendinous junction and tendon insertion. Operative treatment is indicated in isolated complete ruptures of one portion and complete ruptures of both portions of the pectoralis major tendon, predominantly in young active patients with high functional demands. Surgery should be preferably performed without delay, within no more than 6 weeks, in order to ensure the best results. The most common operative technique is reinsertion of the muscle by means of implants or direct suture. In chronic ruptures, it is often necessary to perform a reconstruction with a tendon graft. The results are good, although worse as compared to an early treatment.