After publishing the largest series in the medical literature on pectoralis major tendon
reconstructions in the Journal of Shoulder and Elbow Surgery in 2019 Dr Ruotolo and the team
at Total Orthopedics and Sports Medicine published a review of the treatment of all pectoralis
major injuries in Orthopedic Reviews. This paper highlights the spectrum of injuries of the
pectoralis major tendon and the different treatment options for optimal outcomes.
Pectoralis major ruptures are uncommon injuries but have been more prevalent over the last
several decades due to the increased incidence of weight lifting. Patients often present with
swelling and bruising, a deformity of their pectoralis muscle, loss of the definition of the front
of the axilla (the arm pit) and weakness with pushing or pressing. MRI of the chest (not the
shoulder) is the key to diagnosis. Operative intervention is the treatment of choice for
improved functional outcomes, cosmesis, and patient satisfaction.
For those with a tear of the tendon from the bone the tendon can be repaired directly back to
the bone. For those with tears in the mid tendon or in the muscle tendon junction a
reconstruction can be performed to restore anatomy and function. Dr. Ruotolo has described a
technique of reconstructing the tendon using a hamstring tendon (either from the patient or
donated from a tissue bank) which has shown success to restore strength and function in
multiple patients. His technique and series has been published in the literature. In pectoralis
major tears the key to success is finding a surgeon with experience in diagnosis and surgical
treatment.