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PEARLS & PITFALLS – SURGICAL TECHNIQUE

Pectoralis Major Repair Surgical Technique

A modified and inferiorly positioned deltopectoral
Technical Note incision about 5 cm in length is utilized. The cephalic

Expanding our therapeutic vein is displaced laterally and dissection is carried
until the conjoined tendon is identified. With blunt

armoury
dissection medially, the clavicular and sternal head
are identified, the type of rupture is analyzed and

a decision about how to proceed is made. Often a
Gonzalo Samitier, MD, PhD
large seroma is encountered around the tendon. The

Sports Medicine Fellow at tendon and / or muscle belly are usually retracted
Henry Ford Health System medially approximately 2.5 cm from its insertion point

CLAWSON, MI USA
along with, occasionally, a thin veil of tissue/fascia
still attached to the humeral insertion; but the
majority of the muscle tendon unit is normally torn

and retracted. We first bluntly dissect superficially
as well as posteriorly to the ruptured heads until a

360-degree release is obtained, then two number
Surgical Technique and Senior Author: 2 ultra-resistant Fiberwire © (Arthrex, Inc. Naples,

Kevin W Farmer, MD
FL) locked sutures are placed within the bulk of
Assistant Professor Sports Medicine Division at the muscle tendon unit in a Krackow fashion to be

University of Florida, GAINESVILLE, FL, USA
able to bring this back to the insertion point without
undue tension. After creating a trough in the humerus
Introduction
at the anatomic insertion site lateral to the biceps
Pectoralis major rupture is an injury related tendon, holes are drilled for two Peek Swivelock©
to certain sports or activities as weight lifting 5.5 anchors loaded with #2 fiberwire© (Arthrex,
(especially during bench pressing), American football,
Inc. Naples, FL), appropriately drilled and tapped
wrestling and rugby. As former Shoulder & Elbow into place.
fellow at University of Florida I was exposed to a wide
Then the two prefixed sutures in the tendon can
variety of shoulder, elbow and sports procedures,
some of them, interesting and novel techniques be tied with each other and the preloaded sutures
of anchors are also tied in the same manner over
as the one described below and developed by the
senior author KF.
the pectoralis insertion tendon. At this point it is
advisable to test the external rotation and stability
Pectoralis major function consist in adduction, internal
rotation, and flexion of the humerus. Origin comes of the construct. Finally, the deltopectoral interval is
closed with absorvable sutures and non-absorvable
from the sternum, medial clavicle, aponeurosis of
the external oblique muscle and the cartilaginous intracutaneous sutures are used for the skin.
area of the first six ribs; all them form a complex

composed of multilaminar segments that merge into a
bilaminar tendon.

Classical mechanism of injury is in full extension

and external rotation of the shoulder while trying to
resist a sudden forceful load directed in an anterior
to posterior direction. This overloads the maximally

contracted muscle during eccentric movement.

Classical clinical presentation for this injury is
sudden severe pain in the arm and shoulder, with
or without an audible “snap”, motion accompanied

with pain, ecchymosis, swelling, and weakness;
Physical examination shows asymmetric anatomy

on the axillary fold presenting a thinning on the
affected area or even an area of depression at the

deltopectoral groove and bulging at pectoralis origins
when tensioning is created on the muscle. Muscle
strenght shows weakness in adduction and internal

rotation of the arm.

For diagnosis, radiographs usually do not show
abnormalities except in bony avulsion cases; MRI is
considered the gold standard imaging modality.
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40 ISAKOS NEWSLETTER 2013: Volume II