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Condition/Disorder Synonyms

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  • Torn pectoral

  • Pectoral rupture

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ICD-9-CM Code

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  • 840.8 Sprains and strains of other specified sites of shoulder and upper arm

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ICD-10-CM Codes

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  • S43.499A Other sprain of unspecified shoulder joint, initial encounter

  • S46.819A Strain of other muscles, fascia and tendons at shoulder and upper arm level, unspecified arm, initial encounter

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Preferred Practice Pattern

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Key Features

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Description

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  • Partial or complete rupture of the pectoral muscles

  • Grades of tear1,2

    • Grade 1: Contusion or strain

    • Grade 2: Partial tear

    • Grade 3: Complete rupture

    • Grade 3A: Tear muscle origin

    • Grade 3B: Tear muscle belly

    • Grade 3C: Musculotendinous junction

    • Grade 3D: Muscle tendon itself

  • Four common locations

    • Rupture at the humeral insertion

    • Rupture at the musculotendinous junction

    • Rupture at the muscle belly

    • Muscle torn off the sternum

  • Commonly affects the pectoralis major muscle

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Essentials of Diagnosis

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  • Rare condition

  • Diagnosis is made by history and clinical exam with MRI for confirmation of location

  • Occurs from a sudden high force, typically with weightlifting (i.e., bench or chest press)

  • May arise from a repetitive type activity that leads to a gradual degeneration

  • Sudden pain or tearing sensation in the chest may be experienced

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General Considerations

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  • Swelling, ecchymosis, and functional pain

  • Treatment may depend on location of rupture with tendon avulsion from the humerus treated with prompt surgical repair

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Demographics

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  • More common in men between the ages of 20 and 50 that participate in cotact sports and weight lifting

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Clinical Findings

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Signs and Symptoms

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  • Audible snap or pop at the time of injury

  • Sudden pain or tearing sensation in chest

  • Mild swelling and ecchymosis over anterior lateral chest wall or in proximal arm

  • Loss of normal pectoralis contour

  • Weakness with horizontal shoulder adduction

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Functional Implications

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  • Pushing activities

  • Weight training with overload eccentric contractions: such as bench press, push ups, chin ups, dips, and chest flys can cause a rupture

  • Overhead activities may be limited

  • Inability to lift heavy objects

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Possible Contributing Causes

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  • Abnormal biomechanics

  • Muscle weakness or imbalance

  • Muscle tightness

  • Poor posture with change in humeral head position

  • Excessive or inappropriate activity

  • Inadequate warm up

  • Steroid use

  • Forceful eccentric activity (i.e., bench pressing)

  • Often seen in football and rugby injuries

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Differential Diagnosis

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  • Long head of biceps tendon rupture

  • Shoulder dislocation

  • Proximal humerus fracture

  • Rotator cuff tendon tear

  • Medial Pectoral nerve entrapment

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Means of Confirmation or Diagnosis

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Imaging

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