Physical Therapy in Northern Virginia for Shoulder
Q: Mother is 72-years old but fairly frail and immobile. She tore a muscle in her chest when the nurses aide was helping transfer her from the bed to the chair. The doctor says not to do surgery (and we agree), but I'm just checking to see if you think this is the right decision.
A: The pectoralis muscle is the large muscle across the chest that is most active when doing push-ups or lifting weights.
It is a two-part muscle that attaches above to the clavicle (collar bone) and down the length of the sternum (breast bone). It also attaches by a fairly narrow tendon (thin compared to the muscle size) to the upper arm next to the tendon insertion of the biceps muscle.
Injuries severe enough to rupture the tendon attachment occur most often when the muscle is fully contracted and then slowly lengthens against a weight. This mechanism of injury describes the bench press -- lifting overhead with arms out to the sides, elbows straight, and shoulders externally rotated.
Pectoralis major ruptures have also been reported as a result of work injuries. And this type of injury has been associated with a wide range of activities such as wrestling, sailing, water skiing, snow skiing, rugby and soccer, football, boxing, and even parachuting.
In younger adults, the injuries almost always occur in males between the ages of 20 and 40. Older adults might have this type of injury just as you described -- when they have been helped by others to transfer from bed to chair and vice versa. Pressure under the arms against stiff, weak muscles while being lifted is enough to cause crush injuries, tendon ruptures, and hematomas (pools of blood around or inside the muscle).
Most of the time, surgery is required to repair the damage. It's during the operation that the surgeon gets a close up view and 100 per cent accuracy in the diagnosis. Only older adults are treated conservatively (nonoperative). With rest, support (arm in a sling), and the use of cold and later heat, these injuries can heal enough to allow the less active person to perform normal daily activities without pain.
Reference: CDR Matthew T. Provencher, MD, MC, USN, et al. Injuries to the Pectoralis Major Muscle. In The American Journal of Sports Medicine. August 2010. Vol. 38. No. 8. Pp. 1693-1705.
