The pectoralis major muscle attaches to the humerus (arm bone) via tendons. The pectoralis major muscle is important for forcefully bringing the arm to the midline or across the body, as well as to rotate the arm inward. Pectoralis major ruptures can be a partial or complete tear of the pectoralis major tendon. Typically, the tendon tears off the humerus bone but occasionally the pectoralis may tear at the muscle-tendon junction. When the pectoralis major muscle is significantly or completely disconnected from the humerus bone, the muscle retracts and there is a loss of function of this muscle. This typically results in deformity and loss of the normal contour of the chest and loss of power with pressing or pushing with the arm. Athletic patients who wish to regain full strength and function often elect to have the pectoralis major tear repaired. For patients wishing to avoid surgery, loss of function of the pectoralis muscle does not typically impair normal activities of daily living and may elect to not have it repaired.
Dr Chudik makes a small, limited incision over the anterior shoulder. He then retracts the soft tissues and identifies the torn pectoralis major tendon. The insertion site of the pectoralis major tendon on the humerus bone is also identified and prepared. Suture anchors are placed in the bone along the insertion site on the humerus. Sutures from the anchors are passed through the tendon end of pectoralis major muscle and tied down to reattach the tendon to the humerus bone in its proper position. Sometimes, when the pectoralis major tendon injury and tear is chronic (greater than four to six weeks or more) the tendon may have resorbed and scarred so that there is insufficient tendon to repair back to the bone. In these cases, Dr. Chudik has taken autologous graft from the iliotibial band along the thigh (expendable long flat band of tendon from the patient), folded the tendon graft over the free end of the remainder of the pectoralis major tendon, sutured it into place on the muscle to make a new pectoralis tendon and then repaired the muscle with its new tendon back to the humerus bone as described above. Then the arm is immobilized against the side of the patient for six weeks and it requires four to six months to begin to return to physical activities such as weightlifting.