Pectoralis Major Tendon Ruptures

The pectoralis major is one of the largest and most powerful muscles of the chest. It plays a vital role in moving the arm across the body, rotating the shoulder inward, and helping with pushing movements such as lifting weights or pushing off the ground. The muscle attaches to the upper arm bone (humerus) through a strong tendon. When this tendon tears, it is called a pectoralis major tendon rupture. It is a rare injury that commonly affects men between the ages of 20-30, commonly during a bench press. Although not as common as some other muscle or tendon injuries, a rupture can be painful and significantly limit strength and daily function.

What is a pectoralis major tendon rupture?

A rupture occurs when the tendon connecting the pectoralis major muscle to the upper arm pulls away, either partially or completely. A partial tear means some fibers of the tendon are still attached, while a complete rupture means the tendon has detached fully from the bone.

What are the symptoms of a rupture?

The symptoms of a pectoralis major tendon rupture can vary depending on whether the tear is partial or complete. In most cases, patients describe a sudden, sharp pain in the chest or upper arm during activity, often accompanied by a popping or tearing sensation. Common symptoms include:

• Immediate pain in the chest or front of the shoulder
• Swelling and bruising in the chest, armpit, or upper arm
• Loss of strength when trying to push, press, or bring the arm across the body
• Noticeable deformity, such as a gap or indentation in the chest where the muscle normally sits
• A rolled-up or balled appearance of the chest muscle in cases of complete rupture

Because bruising and swelling may spread quickly, patients often notice discoloration along the upper arm and chest within a day or two of injury.

What causes a Pectoralis Major tendon rupture?

The most common cause of this injury is weightlifting, particularly during the bench press exercise. The tendon is placed under maximum stress when the arms are lowered outward with heavy weight, especially if the chest muscles are fatigued. Other causes include:

• Contact sports such as football, wrestling, or rugby, where the arm may be pulled or forced backward
• Traumatic injuries such as a fall or accident involving sudden force on the arm
• Sudden eccentric contractions of the muscle, where it is stretched while contracting

Though rare, some tendon ruptures are also linked to anabolic steroid use, which can weaken tendon tissue.

How is the condition diagnosed?

Diagnosis begins with a careful review of the patient’s symptoms and a physical examination. Dr. Waterman will look for visible changes in the contour of the chest, swelling, and bruising. During the exam, he may ask the patient to move the arm or test its strength to see how much power has been lost. Imaging tests are often used to confirm the diagnosis and assess the severity:

• X-rays may be used to rule out bone injuries, though they cannot show the tendon directly.
• Ultrasound can provide a quick look at whether the tendon is intact or torn.
• MRI scans give the clearest picture of the tendon and muscle, helping to determine whether the tear is partial or complete and if surgical repair is necessary.

Prompt diagnosis is important because early treatment improves the chances of restoring full strength and function.

What are the risks and complications?

If left untreated, a pectoralis major tendon rupture can lead to long-term weakness, deformity, and loss of shoulder function. Patients may struggle with activities that require pushing strength, such as lifting heavy objects, playing sports, or even routine daily tasks. In addition, untreated ruptures often result in a permanent cosmetic defect, as the chest muscle remains rolled up or shortened.

Delaying treatment can also make surgical repair more difficult. Over time, the tendon retracts, and scar tissue can form, which complicates the ability to reattach it securely to the bone. For athletes and active individuals, this may limit the chances of returning to pre-injury performance.

Anyone who experiences sudden chest or arm pain with weakness after lifting weights, playing sports, or sustaining trauma should seek medical evaluation promptly. Because the symptoms may overlap with other injuries such as shoulder strains or chest muscle pulls, it is important to see a trained orthopedic specialist for an accurate diagnosis.

If you are experiencing sudden chest pain, swelling, or weakness following exercise or injury, it may be more than a muscle strain. Dr. Brian Waterman, a Board Certified and Fellowship Trained orthopedic surgeon and Sports Medicine expert in Winston-Salem, North Carolina, specializes in diagnosing and treating pectoralis major tendon ruptures and other sports-related injuries. With advanced training and expertise, Dr. Waterman can provide a thorough evaluation and guide you toward the best treatment to restore strength and function.

Do not wait to seek care. Contact Dr. Waterman’s office today to schedule an appointment and take the first step toward recovery.