Complex Intratendinous Pectoralis Major Rupture After Heavy Bench Press

A pectoralis major rupture is a rare injury with important strength and cosmetic consequences, most often described in young, active men after a high-load eccentric contraction during the heavy bench press. Magnetic resonance imaging (MRI) is commonly used to confirm the diagnosis and localize the tear, but the location described on MRI may not fully define tendon continuity, tissue quality, or the tendon available for fixation. We report the case of a 23-year-old male powerlifter who developed acute right chest pain, swelling, ecchymosis, deformity, and pectoralis retraction during a 500-lb bench press one-repetition maximum attempt. Preoperative MRI showed a high-grade injury of the sternal head fibers of the right pectoralis major and was interpreted as a grade 3 myotendinous tear with a distal tendon stump measuring approximately 30 mm. The absence of an edema-like signal around the stump supported, but did not prove, a more proximal myotendinous injury with a preserved distal tendon. During surgery, however, the repairable tendon attached to the retracted muscle was more limited than the MRI impression suggested. Exploration showed intratendinous disruption, with only a small tendon remnant attached to the retracted muscle and substantial tendon remaining at the humeral footprint. This changed the repair problem from simple fixation of a robust distal stump to mobilization of limited tendon and adjacent myotendinous tissue, locking whipstitch fixation with high-strength suture tape, unicortical humeral drilling, cortical button fixation, and restoration of the axillary fold and pectoralis contour. At approximately three months, the patient had a full range of motion, near-normal pectoralis strength, preserved contour, and no documented pain, infection, neurovascular deficit, wound dehiscence, rerupture, or other major early complication. This short follow-up cannot establish long-term repair integrity or safe return to maximal bench press. In this patient, MRI identified the high-grade rupture, while intraoperative inspection clarified the repairable tendon available on the retracted muscle.