Pectoralis major repair

Overview

Shoulder joint anatomy showing the humeral head, glenoid socket, and rotator cuff muscles (supraspinatus and infraspinatus). — **Shoulder anatomy.** The shoulder is a shallow ball-and-socket joint. The top of the upper-arm bone (humerus) sits against a small dish on the shoulder blade (glenoid), and four rotator-cuff tendons wrap around the ball to hold it centered during every arm motion.

The pectoralis major drives pushing, bench-pressing, and horizontal adduction of the arm. Ruptures almost always occur at the humeral attachment, typically during heavy eccentric loading — the descent of a bench press is the classic scenario. Without repair, the muscle retracts, push strength is lost, and the contour of the chest is visibly altered.

How the Procedure Works

We retrieve the retracted tendon through a deltopectoral incision, prepare it with heavy locking sutures, and reattach it to the humeral footprint — a broad insertion along the lateral lip of the bicipital groove that is easy to under-restore if the repair is placed too anteriorly. Transosseous tunnels through the humerus are our preference for fixation strength; suture anchors are an alternative when bone quality or geometry makes tunnels impractical. The key intraoperative check is tension: the repaired tendon should lie flat against bone with the arm in slight adduction and internal rotation, and the chest contour should be symmetric. Repair within the first few weeks produces reliably better strength recovery than delayed repair, when scarring and muscle retraction require more dissection and the tissue quality is often degraded.

When to Consider Pectoralis Major Repair

Pectoralis major repair is generally offered when symptoms, imaging, and a trial of non-operative care together point to surgery as the next step. The typical picture includes:

Acute pec major rupture
A sudden tear, typically in a weight-training athlete, with a palpable defect and bruising in the axilla.
Chronic rupture with functional loss
An older rupture with persistent weakness or cosmetic concern that the patient wants addressed.