Pectoralis Major Repair

The choice of technique depends on the severity of the tear and individual patient factors:

• Suture Anchor Repair: Small anchors with attached sutures are placed into the bone to secure the torn tendon back to its attachment site. This is the most common technique for complete tears, providing a strong repair.
• Direct Suture Repair: The torn ends of the tendon are directly stitched together. This technique is usually used for partial tears or when the tendon is still partially attached to the bone.
• Bone Tunnel Technique: In cases where the tendon has pulled away from the bone, small holes (tunnels) are drilled into the bone, and sutures are passed through these tunnels to secure the tendon back in place. This ensures a firm reattachment for the tendon.

Pectoralis major repair surgery is often required in the following scenarios:

• Acute Traumatic Injury: Sudden, forceful movements, such as bench pressing heavy weights, can cause a tear. These injuries commonly occur in weightlifters or individuals engaged in heavy physical activities.
• Sports Injuries: High-impact sports like rugby, wrestling, or martial arts may lead to tears due to the rapid, forceful movements involved in these activities.
• Heavy Weightlifting: Individuals engaged in intense weightlifting are at risk of pectoralis major tears, especially during exercises like bench presses that place significant stress on the chest muscles. A rupture often occurs when the force on the muscle is too great, usually during a maximal lift or effort. This typically happens towards the end of a set or training session when fatigue becomes a factor. At this moment, a snap or pop may be felt or heard, and there might be a noticeable change in the appearance of the muscle due to tendon retraction.
• Chronic Injury: Injuries not treated surgically with 4-6 weeks are deemed chronic as the tendon retracts and direct repair may not be possible. In these cases, a tendon graft may be required. If you have a chronic injury, Mr Chua will make a thorough assessment and discussion with you about the best treatment options in your particular case.

The benefits of pectoralis major repair surgery include restoring strength and function to the affected arm, enabling a return to sports, work, or daily activities. Surgical repair is particularly important for athletes or those who rely on upper body strength, as studies show it leads to greater strength recovery than non-operative treatment.

However, it’s worth noting that older or more sedentary individuals may choose not to have surgical repair. These patients can expect to lose up to 26% of peak torque and 40% of overall strength in shoulder adduction if they opt for non-surgical treatment. Therefore, surgical repair is generally recommended for those wishing to regain normal strength and return to sporting activity or significant weight training.

The risks are generally low but may include infection, which can be treated with antibiotics, and a slight chance of nerve or blood vessel injury. Some patients may also experience shoulder stiffness or weakness, typically managed with physiotherapy.

• Before the Procedure, you will have a thorough consultation with Mr Chua to assess the extent of the tear and discuss the best treatment plan. Imaging tests such as MRI or ultrasound may be performed to confirm the diagnosis. You’ll receive detailed instructions on how to prepare for surgery, including fasting requirements and any medications to avoid.
• During the Procedure, the surgery will be performed under general anaesthesia, ensuring you remain comfortable and pain-free. An incision is made near the armpit, and Mr Soong Chua will carefully reattach the torn tendon to the bone using sutures, anchors, or screws, depending on the chosen technique. The procedure typically lasts around 1 hour.
• After the Procedure, you will be monitored as you recover from the anaesthesia. You may need to wear a sling for 4-6 weeks to protect the repair and allow the muscle to heal. A structured physiotherapy program will be introduced to help you regain shoulder strength and mobility over time. It’s important to follow your physiotherapist’s guidance closely, as this will greatly impact your recovery process. Full recovery can take 3-6 months, depending on the severity of the tear and your commitment to rehabilitation.

• How soon can I start physiotherapy after pectoralis major repair surgery?
  Physiotherapy typically begins 1-2 weeks after surgery, starting with gentle range-of-motion exercises. Your physiotherapist will guide you through a gradual rehabilitation plan, ensuring that you regain strength and flexibility while protecting the repaired muscle.
• Will I be able to lift weights again after surgery?
  Yes, most patients can return to weightlifting and other physical activities after a full recovery, but it’s essential to follow a gradual rehabilitation plan to avoid re-injury.
• Is pectoralis major repair surgery painful?
  There will be some pain and discomfort following the surgery, but this can be managed with pain relief medication and appropriate care.