What is a pectoralis major tear?
The pectoralis major is the large fan-shaped muscle of the chest. It pulls the arm inward and rotates it. Its tendon attaches to the front of the upper arm bone, and that attachment is where most tears occur. These injuries are most common in men between 20 and 50, typically while bench pressing, but they also happen in wrestling, football, rugby and water skiing.
Tears can be partial or complete, and they can happen in the muscle belly, at the junction between muscle and tendon, or where the tendon attaches to bone. Complete tears from the bone are the ones that benefit most from surgery.
What does it feel like?
Many people feel or hear a tearing sensation in the chest or upper arm. Bruising spreads across the chest, armpit and inner arm, and the chest contour looks different, with a loss of the normal fold at the armpit and sometimes a bunched-up muscle. You may notice weakness pushing the arm in toward the body or bench pressing.
Do I need surgery?
For complete tendon tears in active people, repair is usually advised. Partial tears and muscle-belly tears often heal with therapy. Older or less active people who do not mind a change in appearance and some loss of strength may choose to skip surgery.
What happens in surgery?
Dr. Stepanyan reattaches the torn tendon to its footprint on the upper arm bone using anchors or other fixation, through an incision at the front of the armpit area. If a tear is old, scarred tendon may need to be mobilized or reinforced with a graft, which is one reason early evaluation is helpful.
Should I get a second opinion?
If an MRI shows a tear and you have been told it will heal on its own, or you were told it is too late for repair, a second opinion is worthwhile. Request a visit and mention the injury date.
Where can I see Dr. Stepanyan?
Dr. Stepanyan sees shoulder patients in Glendale, East LA and Santa Fe Springs.
What does recovery look like?
These are the typical stages in Dr. Stepanyan’s physical therapy protocol after a pectoralis major repair. Your own plan may differ.
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First 6 weeks
Protect the repair
You wear a sling except for exercises. Elbow, wrist and hand motion, gentle pendulums, and passive forward motion on your back limited to 90° are allowed. You avoid reaching behind your body and active chest use.
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Weeks 6–12
Restore motion
The sling comes off. Motion gradually progresses, with scapular strengthening and cuff and deltoid isometrics. No resisted inward rotation or pulling the arm in, push-ups, heavy lifting or sports.
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Weeks 12–16
Full motion and early strength
You have full motion. Light pectoralis strengthening begins, along with cycling and running.
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Weeks 16–22
Build strength
Strengthening progresses to chest press, flys and push-ups, with plyometrics, and throwing programs for throwers. No sport until Dr. Stepanyan clears you.
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Week 22 and beyond
Return to play
Strength training intensifies. High-weight, low-rep bench press is avoided. Return to unrestricted activity requires clearance.
Dr. Stepanyan’s therapists follow his written pectoralis major repair protocol. If anything here differs from what you were told, follow your own plan.