How Is a Pectoralis Major Tendon Repaired?
To treat a pectoralis major tendon tear, our shoulder surgeon, Dr. Charles Ruotolo, first evaluates the severity of your injury using physical examination and imaging. If the tendon is completely torn, he may recommend surgery to reattach the tendon to the upper arm bone. In this procedure, Dr. Charles Ruotolo makes an incision to access the torn tendon and reposition the tendon to its normal position.
After the surgery, our team at Total Orthopedics & Sports Medicine guides you through stretching and strengthening exercises to restore your shoulder stability. We also offer follow-up appointments to monitor your tendon healing and help reduce the risk of future shoulder complications during recovery. Call 855-321-6784 to book your appointment with Dr. Charles Ruotolo.
What Surgical Methods Are Used to Repair a Pectoralis Tendon?
Arthroscopy, muscle reattachment, or open reduction and internal fixation can help repair damage to the pectoralis major muscle. In more severe cases, surgeons may also use cortical button fixation, along with allograft reconstruction procedures, to restore your shoulder strength. Here’s how these shoulder surgeries can help relieve pain in the pectoralis tendon:
Arthroscopy
In arthroscopy, your shoulder specialist inserts thin surgical instruments through small incisions to assess the pectoralis major muscle damage. This method helps remove inflamed tissue, repair partial tears, and improve shoulder stability.
It may also reduce pressure on nearby nerves and damaged structures that are causing pain. Since the incisions in this procedure are small, you may often experience minimal soft tissue disruption and reduced postoperative discomfort.
Muscle Reattachment
In muscle reattachment surgery, surgeons make an incision near your chest to access the torn tendon and remove scar tissue. After the incision, they pass sutures through the tendon and secure them into the bone using anchors or fixation devices, such as:
- Bone tunnels
- Interference screws
- Fixation plates
- Tendon anchor systems
- Biocomposite fixation devices
These fixation devices help keep the repaired pectoralis tendon securely attached to the bone during healing. Moreover, this method helps restore the normal coordination between the chest muscle and the arm. It also improves shoulder stability, rebuilds chest strength, and supports smooth arm movement during daily activities.
Open Reduction and Internal Fixation
Open reduction and internal fixation (ORIF) is commonly used to treat severe shoulder fractures involving the surrounding bone structures, including:
- Proximal humerus
- Humeral shaft
- Rotator cuff
- Greater tuberosity
- Clavicular head
- Sternal head
- Clavicle
In this procedure, the surgeon repositions damaged tissue and stabilizes the area using screws, plates, or surgical hardware. This method helps secure the tendon and maintain proper shoulder alignment during healing. Additionally, this surgical intervention is often recommended after traumatic injuries or complete tears. Open reduction and internal fixation may also help reduce long-term weakness and chronic shoulder pain.
Allograft Reconstruction
In allograft reconstruction, surgeons use donor tendon tissue to replace the damaged pectoralis tendon. This graft is carefully secured to the upper arm bone and the healthy tendon using strong sutures and fixation devices. This technique helps restore the normal tendon length and chest muscle strength. Over time, the tendon graft integrates with your surrounding tissue, supporting long-term healing and improved upper-body function.
For example, a co-authored research by Dr. Charles Ruotolo evaluated outcomes of pectoralis major (PM) ruptures treated with open reconstruction using a semitendinosus allograft. This study included 6 patients, with an average age of 39.5 years. All patients underwent a standardized pectoralis major repair followed by a structured rehabilitation program.
At the 12-month follow-up, outcomes showed excellent recovery results, including:
- American Shoulder and Elbow Surgeons (ASES) score: 98.3
- Constant score: 98
- Visual Analog Scale (VAS) pain score: 0.67
Cortical Button Fixation
During button fixation, surgeons make small holes in the bone and pass the fixation buttons through the opposite side of the bone cortex. This method helps keep the tendon in place while healing. Cortical button fixation may also provide strong tendon-to-bone compression, which supports tissue healing.
Who Is At Higher Risk of Pectoralis Major Tendon Tear?
People who regularly participate in heavy weightlifting, powerlifting (especially bench press training), or perform repetitive upper-body movements are at a higher risk of a pectoralis major tendon tear. Other than that, according to the NCBI, pectoralis major tears most commonly occur in young, physically active males in the third and fourth decades of life.
Additionally, improper lifting techniques, poor shoulder flexibility, and muscle imbalance can increase stress on the tendon. This stress can lead to tendon fiber damage over time, making the tendon weaker and more prone to acute tears. Contact sports such as football, wrestling, rugby, and martial arts can also lead to sudden pectoralis major tendon injuries. Here’s how these sports can damage your pectoralis major tendon and increase the risk of muscle tears over time:
Wrestling
Wrestling is one of the high-risk sports for pectoralis major tendon tears. During wrestling, opponents frequently force each other’s arms into full extension and internal rotation. This extreme rotation puts intense stress on the pectoralis major tendon, especially when the chest muscle contracts while resisting an opponent’s force. Similarly, sudden pulling or twisting movements in wrestling can overstretch tendon fibers and lead to acute injuries over time.
In fact, according to NCBI, researchers at the University of Calgary Sport Medicine Center reviewed cases of pectoralis major (PM) injuries in professional Rodeo Steer Wrestlers. After the research review, the researchers revealed the following results:
- Total PM injury cases: 34 patients
- PM ruptures in rodeo athletes: 6 cases
- Additional CPRSMT-identified cases: 4 cases
- Total professional steer wrestlers with PM ruptures: 9 cases (all right arm, distal humeral insertion)
- Age range: 30–51 years (mean 35 ± 7 years)
- Injury location: distal pectoralis major insertion into the humerus
- Previous injury history: 44.4% had prior right shoulder injury
- Previous PM strain history: 44.4% had prior pectoralis major strain
- No prior shoulder or PM injury: 33.3% of cases
- Injury mechanism (steer wrestling): 77.8% during the throwing phase
- Injury mechanism (fall): 22.2% occurred during a fall with the arm abducted and extended
Rugby
Rugby can increase the risk of a pectoralis major tendon tear due to repeated collisions, tackles, scrummaging, and forceful upper-body contact. During scrums and defensive plays, players must push against opponents, which places intense pressure on the chest and rotator cuff muscles. At the same time, the pectoralis major muscle contracts at high intensity to stabilize the arm.
However, a sudden impact can stretch the muscle while it is still contracting, causing excessive strain on the tendon fibers. Over time, repeated physical contact and heavy upper-body loading may weaken the tendon. This weakness can reduce the tendon’s ability to handle sudden forces, making it more prone to partial or complete tears.
Martial Arts
In martial arts, strikes such as punches put a sudden load on the pectoralis major muscle. Similarly, grappling, clinching, and throwing techniques force your arm into extended positions, increasing tension on the tendon. This repeated pattern of contraction can lead to microtears within the tendon fibers over time.
Football
Football can increase the risk of a pectoralis major tendon tear due to sudden, high-force contact during blocking, tackling, and pushing movements. In this sport, players frequently extend their arms forward while resisting another player’s weight, which can put pressure on the pectoralis major tendon. This pressure can weaken your tendon fibers over time, leading to chronic tears within the tissue.
How Do Doctors Diagnose a Pectoralis Major Tear?
To diagnose a pectoralis major tear, our sports surgeon, Dr. Charles Ruotolo, may order detailed imaging tests, such as X-rays, MRIs, or ultrasounds. X-rays can help rule out bone injuries, such as fractures or avulsion injuries, at the tendon attachment site. Similarly, ultrasound can help detect soft-tissue damage, tendon retraction, or partial tears in the pectoralis major tendon.
In addition, according to research by Dr. Charles Ruotolo et al., chest MRI is the most accurate imaging for diagnosing partial- and full-thickness tears of the pectoralis major muscle. To confirm the diagnosis, our surgeon may also conduct the following physical examination:
- Hands-on palpation: Helps locate tenderness, swelling, or gaps in the muscle or tendon, which can reveal the exact injury site
- Movement testing: Evaluate shoulder mobility and identify limitations in arm motion caused by pain or tendon disruption
- Visual assessment: Identify chest asymmetry, bruising, or a loss of normal muscle contour, which may indicate a tendon rupture
- Strength evaluation: Helps measure weakness during pushing or shoulder adduction movements
- Functional testing: Reproduce pain during chest press or resistance activities, confirming difficulty with daily and sports movements
Beyond imaging and physical tests, our fellowship-trained surgeon, Dr. Charles Ruotolo, may also review your medical history. While reviewing your condition, he may ask questions such as when your shoulder pain started or whether you felt a sudden popping sensation during activity. He may also ask whether you participate in football, wrestling, rugby, or other contact sports that place stress on the pectoralis major tendon. This detailed assessment helps identify the exact cause of the injury and determine the most appropriate treatment plan for your condition. Call us today at 855-321-6784 for an accurate diagnosis.
What Happens If a Pectoralis Tendon Tear Is Left Untreated?
If you leave a pectoralis major tendon tear untreated, the damaged tendon can worsen and significantly reduce your upper-body strength and shoulder stability. The torn tendon may also progressively retract from its normal attachment point, making it more difficult for the muscle to heal naturally. As a result, patients often develop persistent chest and shoulder pain and noticeable weakness during pushing or lifting movements.
In more severe cases, pectoralis tendon tears can lead to structural shoulder and chest damage, such as:
- Permanent pectoralis muscle deformity due to tendon retraction and loss of normal muscle contour
- Scar tissue formation around the torn tendon, leading to long-term stiffness and reduced flexibility
- Abnormal muscle imbalance between the injured and uninjured side, affecting posture and strength
- Irreversible loss of tendon function, resulting in reduced power during pushing
- Muscle atrophy within the chest and upper arm due to long-term tendon dysfunction
- Degeneration of the tendon attachment site on the humerus and sternum over time
- Fatty infiltration of the chest muscle (healthy muscle tissue is replaced by fat due to long-term dysfunction)
What Follow-Up Care Is Needed After a Tendon Repair?
After a pectoralis tendon repair, you may need sling immobilization to protect the repaired tendon and routine follow-up visits to monitor healing. During the follow-up visits, our surgeon, Dr. Charles Ruotolo, carefully evaluates your surgical site to ensure proper wound healing and checks for any signs of complications such as:
- Infection around the surgical incision site
- Excessive swelling or fluid buildup near the repaired tendon
- Tendon re-rupture or failure of the tendon repair
- Shoulder stiffness and reduced range of motion
- Persistent chest or shoulder pain after surgery
- Scar tissue buildup affecting shoulder flexibility
- Nerve irritation causing numbness or tingling sensations
- Muscle atrophy within the chest or upper arm area
In addition to monitoring complications, Dr. Charles Ruotolo may also assess your shoulder strength, chest muscle function, and overall arm mobility during each follow-up visit. Other than that, he may prescribe pain medications, cold therapy, and temporary activity restrictions to reduce stress on the healing tendon. If you have questions about your recovery instructions or need additional support during the healing process, you can call us at 855-321-6784 for a follow-up appointment.
How Long Does a Torn Pectoralis Major Tendon Take To Heal?
The pectoralis major tendon typically takes 6 to 9 months to fully heal after surgical repair. In the first 6 weeks, you may need to wear a sling to protect the repaired tendon and limit shoulder movement. During this period, our surgeon may also recommend avoiding heavy lifting, pushing movements, and high-impact upper-body activities to reduce stress on the healing tendon. Here’s how your recovery may progress after 6 weeks:
- 6–8 weeks: The tendon strengthens, and our surgeon may allow gentle shoulder movement to gradually improve mobility.
- 8–12 weeks: Shoulder motion improves further, and basic daily activities become easier as pain and stiffness gradually decrease.
- 3–4 months: Strength begins to return in the chest and shoulder, with controlled light upper-body use under medical guidance.
- 4–6 months: Functional strength improves significantly, allowing more active use of the arm in daily tasks and light resistance activities.
- 6–9 months: Final healing phase where the tendon heals fully, and most patients return to full activity.
What Is the Success Rate of Pectoralis Tendon Repair?
The success rate of pectoralis tendon repair is approximately 90%. In fact, an NCBI systematic review assessed 18 studies with a total of 536 patients who underwent isolated pectoralis major tendon repair. The researchers found that 90% (134/149) of patients returned to sport, and 74% (95/128) successfully returned to their pre-injury level.
Moreover, the average time to return to sport was 6.1 ± 1.7 months, while 95% (269/284) returned to work at 6.9 ± 1 months. Complete pain relief was also reported in 81% (83/102) of patients, while 19% (21/109) had cosmetic concerns. However, the overall complication rate was 18% (75/423), including reruptures and wound infections, and 7% (30/423) required reoperation.
How Can You Reduce the Risk of Future Tendon Injuries?
To reduce the risk of future tendon injuries, use proper lifting techniques during bench press exercises and avoid putting pressure on the pectoralis tendon. You should also warm up before exercise and gradually increase your upper-body training intensity. Besides that, avoid lifting heavy weights and performing repetitive chest-loading exercises after an injury.
Moreover, perform the following strengthening exercises to reduce the risk of future tendon injuries and protect your shoulder function:
- Resistance Band External Rotations: Keep your elbow close to your side and slowly rotate your forearm outward against the resistance band.
- Scapular Retraction Exercises: Pull your shoulder blades backward and hold the position for a few seconds before relaxing.
- Wall Push-Ups: Stand facing a wall and perform controlled push-ups against it.
- Shoulder Blade Squeezes: Sit or stand upright and gently squeeze your shoulder blades together without raising your shoulders.
- Pendulum Shoulder Swings: Lean slightly forward and allow your arm to swing gently in small circles.
Book an Appointment With Dr. Charles Ruotolo for Advanced Pectoralis Tendon Treatment!
While pectoralis major tendon repair can help restore shoulder strength, the procedure may still lead to complications if performed by an inexperienced shoulder specialist. Poor surgical technique may also increase the risk of scar tissue buildup, muscle deformity, and reduced chest muscle strength over time.
Recognized by Castle Connolly as a top doctor, Dr. Charles Ruotolo at Total Orthopedics and Sports Medicine has performed several pectoralis major tendon repair surgeries to help patients regain shoulder stability. Our team also uses specialized surgical techniques and structured post-surgical care to support long-term tendon healing and reduce the risk of future complications. Call 855-321-6784 or visit us at 500 Commack Road, Bldg E, Suite 150B, Commack, NY 11725 to book your appointment.
FAQs
Can a Pectoralis Major Tendon Tear Heal Without Surgery?
Yes, a pectoralis major tendon tear can sometimes heal without surgery, but this generally depends on the tear’s severity and location. For instance, mild or partial tendon tears may improve with non-surgical treatment. However, complete tendon tears often do not heal properly without surgical repair.
Is Pectoralis Tendon Repair Considered a Major Surgery?
Yes, pectoralis major tendon repair is generally considered a major orthopedic surgery because it involves reattaching a torn tendon to the upper arm bone (humerus). This procedure is typically performed under anesthesia and may require specialized techniques, such as sutures or fixation devices, to properly secure the tendon.
When Is the Best Time to Repair a Torn Pec Tendon?
For the best possible surgical outcome, a torn pectoralis tendon should be repaired within the first few days after the injury. Early surgical treatment allows the tendon to be repositioned more effectively. But if you delay treatment, the torn tendon may lead to scar tissue at the injury site.
Can You Still Work Out After a Pec Tendon Repair?
Yes, you can usually work out after a pectoralis major tendon repair. However, during the early recovery stage, you should avoid bench press and push-up exercises. These exercises can put excessive pressure on the healing tendon and increase the risk of tendon re-rupture during the early recovery phase.
What Movements Should I Avoid After Tendon Repair?
After a pectoralis major tendon repair, you should avoid forceful pushing, sudden pulling, and rapid arm extension. You should also avoid sudden twisting motions, repetitive upper-body strain, and activities that require significant chest muscle contraction. Additionally, do not lift heavy objects and perform overhead movements.
