Pectoralis Tendon Rupture in Vienna
While lowering the barbell or breaking a fall, the large chest muscle gives way abruptly: a snap, a stabbing pain at the front of the armpit, and shortly afterwards a bruise over a wide area. A torn tendon does not grow back onto the bone by itself, and while it is fresh it is easier to fix than once it has scarred. I assess the findings at short notice.
In short
A pectoralis tendon rupture (rupture of the tendon of the large chest muscle) almost always happens when the abducted arm gives way suddenly under high load — in strength sports classically while lowering the barbell. Typical signs are an audible snap, immediate pain, a bruise across the chest and upper arm and a flattened anterior axillary fold with loss of strength when pressing. I confirm the diagnosis in the consultation, in an examination comparing both sides and with ultrasound in my practice; to assess the shape of the tear and the retraction of the tendon I arrange an MRI. As a rule I fix the torn tendon back onto the humerus — also with a partial tear, and as soon as possible, because the tendon retracts and scars over time; the procedure is tissue-sparing, through a small incision at the anterior axillary fold.
What is a pectoralis tendon rupture?
The large chest muscle arises from the collarbone, the breastbone and the ribs; its fibres converge into a strong, flat tendon that attaches at the front of the humerus. It pulls the arm forwards and towards the midline of the body and rotates it inwards — every pressing movement runs through it. When this connection tears, it usually affects the tendon at its insertion, less often the junction between muscle and tendon.
The mechanism is characteristic: the abducted, outwardly rotated arm gives way under maximum tension — while lowering the barbell, when wrestling or in contact sports. Those affected are almost always men active in strength sports; I know these loads from my own experience with American football, strength sports and ball sports. At first the tear is often mistaken for a muscle strain; it is one of the injuries I see regularly in shoulder surgery. A similar snap near the shoulder or at the elbow points rather to a biceps tendon tear; examination and ultrasound separate the two.
Typical symptoms
- Snap or tearing under load — the moment stays in the memory, together with a stabbing pain at the front of the armpit.
- Bruising — over a wide area across the chest, armpit and upper arm, often fully visible only the next day.
- Flattened axillary fold and changed contour — the palpable edge of the tendon is missing when both sides are compared; on tensing, the muscle moves towards the middle of the chest.
- Loss of strength — when pressing, when drawing the arm in and when rotating it inwards.
- Swelling and pain on movement — above all when lifting the arm away from the body and rotating it outwards.
How I make the diagnosis
It starts with a detailed consultation: which movement, against what resistance, what did you hear and feel? The clinical examination follows, comparing both sides — I palpate the anterior axillary fold, assess the contour with the muscle relaxed and tensed and test the strength when drawing the arm in (adduction) and when rotating it inwards (internal rotation).
Ultrasound is available in the practice; it shows the tendon while it moves and in comparison with the healthy side. Where needed I arrange an X-ray or an MRI, in order to assess the form of the tear, its extent and the retraction of the tendon. Both examinations take place outside the building; I go through the reports with you.
Treatment: reconstructing the torn tendon
A pectoralis tendon rupture is one of the injuries where I advise surgery early and clearly; with patients who are active in sport that holds without qualification. The avulsed tendon does not grow back onto the bone by itself, and it retracts further as time passes. That applies not only to a complete avulsion: I reconstruct a partial tear of the tendon as well, because the remaining part does not carry the pressing load in the long run and can tear further. For the result of the reconstruction, every day and every week counts.
That is why I assess a suspected rupture at short notice and plan the procedure promptly. While the tendon is fresh it can be led back into its bed on the humerus. With an older tear it is shortened and scarred, the procedure becomes more demanding, and at times a tendon graft is needed.
How I operate
The approach lies at the front, at the axillary fold, and it stays small: I work through a short, tissue-sparing incision (minimally invasive technique), free the retracted tendon from the scar tissue and fix it back onto the humerus with suture anchors or with sutures passed through the bone. Unlike many procedures at the shoulder, this step cannot be done with arthroscopic keyhole surgery — the tendon has to be brought back into its bed under direct view.
I carry out necessary procedures at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus, and I accompany you from planning through the procedure to aftercare. I describe the way back to full loading under sports orthopaedics.
When a non-surgical route comes into question
Not every finding leads to the operating theatre. If the tear lies in the muscle belly rather than at the tendon, I treat conservatively: first relief from load, cooling and usually a sling, then guided movement and build-up through physiotherapy. I take the same route where the demands on pressing strength are very low, or where other illnesses argue against a procedure. Physiotherapy, exercise therapy and a chiropractor are in the same building at the Orthozentrum Döbling. If an irritated state remains at the tendon insertion, an ultrasound-guided injection can ease the symptoms.
I name that limit openly: without refixation, the loss of strength when pressing and the changed contour of the anterior axillary fold remain. I set this out before a decision against a procedure is taken.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. For operations, direct settlement with supplementary private insurance is possible; details are set out under procedure and billing in a private practice. Whether an operation makes sense depends on the findings; the decision is taken together.
Frequently asked
Common questions about a pectoralis tendon rupture
Usually the moment is unmistakable: a snap while lowering the barbell, then a stabbing pain at the front of the armpit. Over the following days a bruise spreads across the chest and the upper arm, the anterior axillary fold flattens, and pressing as well as drawing the arm in lose their strength.
As a rule, yes. Both a complete avulsion of the tendon from the humerus and a partial tear should be reconstructed, and as early as possible: the tendon retracts and scars, so every day and every week counts for the reconstruction. I take a non-surgical route above all with tears within the muscle belly, where the demands on pressing strength are very low, or where other illnesses argue against a procedure. Whether an operation makes sense depends on the findings; the decision is taken together.
As soon as possible. A fresh tendon can as a rule be fixed back to the bone directly; once it retracts and scars, the procedure becomes more demanding. You will usually get an appointment within a week, and for acute cases I offer times outside the regular consulting hours. You do not need a referral.
Ultrasound is available in the practice and shows the tendon while it moves and in comparison with the other side. To plan a procedure I also want to know how far the tendon has retracted and whether the muscle belly is involved; for that I arrange an MRI and add an X-ray where needed.
The approach lies at the front, at the axillary fold, and it stays small. Through a short, tissue-sparing incision I free the retracted tendon from the scar tissue, prepare its bed on the humerus and fix it with suture anchors or with sutures passed through the bone. This step is not possible with the keyhole technique. I discuss the procedure and the aftercare with you in detail beforehand.
That is exactly the aim of the aftercare: to build up movement and strength to the point where training becomes possible again. The way there leads through immobilisation, guided movement and a step-by-step build-up of strength with physiotherapy; pressing under heavy weight comes last. When each step is due depends on the operative findings and on how healing progresses.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
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