Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Torn pectoralPectoral rupture ++ 840.8 Sprains and strains of other specified sites of shoulder and upper arm ++ S43.499A Other sprain of unspecified shoulder joint, initial encounterS46.819A Strain of other muscles, fascia and tendons at shoulder and upper arm level, unspecified arm, initial encounter ++ 4E: Impaired joint mobility, motor function, muscle performance, and range of motion associated with localized inflammation +++ Description ++ Partial or complete rupture of the pectoral musclesGrades of tear1,2Grade 1: Contusion or strainGrade 2: Partial tearGrade 3: Complete ruptureGrade 3A: Tear muscle originGrade 3B: Tear muscle bellyGrade 3C: Musculotendinous junctionGrade 3D: Muscle tendon itselfFour common locationsRupture at the humeral insertionRupture at the musculotendinous junctionRupture at the muscle bellyMuscle torn off the sternumCommonly affects the pectoralis major muscle +++ Essentials of Diagnosis ++ Rare conditionDiagnosis is made by history and clinical exam with MRI for confirmation of locationOccurs 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 degenerationSudden pain or tearing sensation in the chest may be experienced +++ General Considerations ++ Swelling, ecchymosis, and functional painTreatment may depend on location of rupture with tendon avulsion from the humerus treated with prompt surgical repair +++ Demographics ++ More common in men between the ages of 20 and 50 that participate in cotact sports and weight lifting +++ Signs and Symptoms ++ Audible snap or pop at the time of injurySudden pain or tearing sensation in chestMild swelling and ecchymosis over anterior lateral chest wall or in proximal armLoss of normal pectoralis contourWeakness with horizontal shoulder adduction +++ Functional Implications ++ Pushing activitiesWeight training with overload eccentric contractions: such as bench press, push ups, chin ups, dips, and chest flys can cause a ruptureOverhead activities may be limitedInability to lift heavy objects +++ Possible Contributing Causes ++ Abnormal biomechanicsMuscle weakness or imbalanceMuscle tightnessPoor posture with change in humeral head positionExcessive or inappropriate activityInadequate warm upSteroid useForceful eccentric activity (i.e., bench pressing)Often seen in football and rugby injuries +++ Differential Diagnosis ++ Long head of biceps tendon ruptureShoulder dislocationProximal humerus fractureRotator cuff tendon tearMedial Pectoral nerve entrapment +++ Imaging ++ RadiographsMRIDiagnostic ultrasound ++ Radiographs may show avulsion from humerusMRI can be useful in assessing location and severity of tearAcute tears will demonstrate hemorrhage and edema and chronic tears will demonstrate fibrosis ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth