You are here

Pectoralis Major Tendon Repair

proximal humerus bone anatomy

synonyms: pec major repair, pectoralis major reconstruction

Pectoralis Major Repair An

Pectoralis Major Repair Anatomy

  • Pec tendon is 5 cm wide, 1 cm long on the anterior surface, and 2.5 cm long on the posterior surface. It consists an anterior lamina(clavicular head), and a posterior lamina is formed by the sternal head.
  • The fascia surrounding the pectoralis major is continuous with the fascia of the brachium and the medial antebrachial septum. This fascia presents as a palpable cord in the axilla and may be mistaken for an intact pectoralis major tendon.
  • Most common rupture is a tendon avulsion, but can be a rupture at the myoteninous junction, bony avulsion, tendon mid substance rupture, or muscle belly tear.
  • Some consider three heads of origin: clavicular, sternal and abdominal (Wolfe SW, AJSM 1992;20:587)

Pectoralis Major Repair Indications

  • Complete pectoralis major tendon rupture
  • Isolated sternal head of pectoralis major rupture
  • Complete pectoralis moajor rupture at eh myotendionuous juntion

Pectoralis Major Repair Contraindications

  • Partial low-grade pectoralis major tendon ruptures
  • Complete Sternoclavicular origin ruptures
  • Pectoralis major muscle belly rupture (relative)

Pectoralis Major Repair Alternatives

  • Non-operative treatment (associated with strength deficits and limited return to athletic activity for complete distal tendon tears)

Pectoralis Major Repair Pre-op Planning / Special Considerations

  • Have Achilles tendon allograft available and discuss allograft use with patient pre-operatively. (Joseph TA, JSES 2003;12:101)
  • Consider MRI to determine location of rupture and amount of retraction. Chronic injuries at the muscle-tendon junction that demostrate fatty infiltrate on MRI will be difficult to mobilized / repair with a successful outcome.

Pectoralis Major Repair Technique

  • Pre-operative antibiotic
  • Anesthesia: GETA +/- interscalene / supraclavicular block
  • Postion: Modified beach chair, all bony prominences well padded.
  • EUA:
  • Prep and drape in standard sterile fashion.
  • Deltopectoral incision. Slightly more medial proximally to access the retracted tendon. Slightly more lateral distally to access the pec major insertion.
  • The anterior laminar fibers from the clavicular head, scar tissue and the anterior fascia may give the false appearance of an intact tendon.
  • Bluntly dissect to the ruptured sternal portion of the pectoralis major tendon, which lies posterior and usually is retracted medial to the clavicular insertion.
  • Mobilize, excise poor tissue and place stay sutures in the tendon end.
  • Identified the insertion site just lateral to the long head of the biceps and lateral to the bicipital groove.
  • Prepare bone bed and repair tendon to bone using bone tunnels or suture anchors. 3-5 anchors are typically required. Sutures are tied with the arm in neutral.
  • Intramuscular ruptures are repaired with modified Kessler technique using Multiple no. 2 braided nonabsorbable sutures placed in three layers beginning in the posterior fascia, followed by a middlel ayer, and finally by placing a third layer through the anterior fascia and muscle. (Kragh JF Jr, JBJS 2002;84A:992)
  • Irrigate
  • Close in layers.

Pectoralis Major Repair Complications

  • Persistent weakness
  • Infection
  • Myositis Ossificans
  • Shoulder stiffness (abduction)
  • Re-rupture / failure

Pectoralis Major Repair Follow-up care

  • Post-op: Shoulder immobilizer for 4-6 weeks. Elbow/wrist/hand ROM exercises.
  • 7-10 Days: Start pendulum ROM exercises.
  • 6 weeks: gentle passive ROM gradually advanced to full ROM and gentle periscapular strengthening started.
  • 3 months: ROM should be nearly full and Pectoralis major muscle strengthening is begun.
  • 6 months: push-ups and dumbbell bench presses with light weight and high repetition are started.
  • 9 to 12 months: return to full-activities. High-weight, low repetition barbell bench pressing is discouraged indefinitely.

Pectoralis Major Repair Outcomes

  • Subjective ratings: 96% for acute repair, 93% for chronic repair, 51% for nonoperative treatment. (Schepsis AA, AJSM 2000;28:9)
  • Isokinetic adduction strength testing: acute repair = 102% of the opposite side; chronic injury repair =94%: nonoperative treatment=71%. (Schepsis AA, AJSM 2000;28:9).

Pectoralis Major Repair Review References

Petilon J, JAAOS 2005;15:59




The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer