Pectoralis major rupture
A rare acute injury caused by avulsion of the pectoralis major tendon and usually seen in weightlifters. Diagnosis is generally made clinically and is confirmed with MRI studies. Treatment is usually surgical repair when presenting acutely. Epidemiology Incidence rare injury (< 1 per 100,000 per year) that is increasing in incidence 75% of all reported cases have occurred since 1990 Demographics almost exclusively seen in males (20-40 years of age) often occurs in weightlifters commonly during bench-pressing Location most commonly occurs as a tendinous avulsion sternocostal head of the pectoralis major tendon is the most common site of rupture Risk factors anabolic steroid use Etiology Pathophysiology mechanism excessive tension on a maximally eccentrically contracted muscle occurs during the downward portion of a bench press, with the arm in the final 30 degrees of humeral extension while pushing against heavy resistance tendon fails in a predictable sequence inferior fibers of sternocostal head fail first then superior fibers of the sternocostal head finally the clavicular head