Shoulder injuries during weightlifting I: rupture of the pectoralis major tendon

Why do pectoralis major tendon tears occur?

Pectoralis major tendon ruptures have been an injury on the rise in recent years. This increased incidence is likely due to increased resistance training and concentrated efforts to increase the volume of this muscle for functional or aesthetic purposes, as it is an important source of energy for upper extremity exercises.

The literature links up to 70% of pectoralis major injuries to bench pressing, an exercise frequently performed by this type of athlete. The forced abduction or elevation of the arm in this exercise causes an eccentric contraction that exceeds the tendon's resistance.

How is pectoralis major tendon rupture diagnosed?

It is diagnosed clinically. Sudden pain, ecchymosis (hematoma), a palpable hollow or defect in the anterior part of the axilla, and decreased height of the nipple on the side of the injury. The diagnosis is usually confirmed with the support of MRI or ultrasound.

Where is a pectoralis major tendon injury located?

The typical location of this injury is controversial in the literature. Some studies locate the injury more frequently at the tendon-to-bone junction. Other studies report a more frequent injury location at the muscle-tendon junction. The latter usually receive conservative treatment in most cases, while tendon avulsions (tendon avulsions from the bone) usually require surgical treatment.

What is the treatment for a pectoralis major tendon rupture?

Conservative or nonsurgical treatment is usually recommended for partial tendon tears or injuries at the muscle-tendon junction in the absence of weakness. It involves immobilization with a sling in an internally rotated position for 3 weeks. Active and passive mobility exercises are then introduced, with a gradual increase in strengthening exercises over the following weeks. Surgical treatment is indicated in cases of complete avulsion of the tendon from its insertion into the humerus. Various techniques are used to reanchor the tendon at the bone insertion site. Ruptures that have lasted more than three months, with tendon retraction and shortening, require surgical intervention with tendon reconstruction.

Several studies have compared the results of conservative treatment with surgical treatment in the case of complete ruptures. In this regard, it should be noted that nonsurgical treatment is associated with a 50% reduction in strength in these studies, compared to a 15% reduction in strength in the case of athletes who underwent surgery. In general, the literature reports better functional results with surgical treatment in complete ruptures of the pectoralis major tendon.

What are the musculoskeletal injuries associated with weightlifting?

Both weightlifting (weightlifting or Olympic weightlifting) and powerlifting are disciplines whose primary focus is on maximal strength in a single attempt. In weightlifting, there are two events: the snatch and the clean and jerk, while powerlifting consists of three events: the squat, the bench press, and the deadlift.

Imbalances between training load and recovery have been postulated as determining factors in the onset of musculoskeletal injuries in this sport, as has lifting heavy loads in extreme joint positions.

While acute injuries such as tears, sprains, lacerations, or bruises are common and often lead to discontinuation of sports practice, there are overuse or overuse injuries that appear gradually and with which the athlete lives and trains regularly.

According to various studies, the injury incidence in weightlifting is between 2.4 and 3.3 injuries per 1,000 hours of training. Acute injuries are the most common, accounting for 60–75% of injuries. Chronic injuries are usually associated with overuse and constitute the remaining 25-40%. In the literature, they are associated with older athletes, with higher rates of tendinopathy, previous tendon ruptures, and degenerative joint problems. The shoulders, knees, lower back, and wrists account for the majority of injuries, most frequently affecting tendons and muscles.

Some determining factors in the onset of these injuries are technical errors (present in 30% of injuries), fatigue or overload (present in 82% of injuries), and accidentally dropping weights (the most common injury mechanism in acute injuries).

Regarding the most common upper extremity injuries, we frequently find:

• muscle strains and ligament sprains
• ruptures of the pectoralis major tendon
• ruptures of the distal biceps brachii tendon
• chronic shoulder pain
• capsular and labral injuries

What are the health benefits of weightlifting?

In recent years, the health benefits of weightlifting have become evident, such as lower blood pressure, improved blood glucose control, maintenance of bone mineral density, and resistance to fat accumulation. Its benefits have also been demonstrated in older adults and adolescents, groups in which there has always been reluctance to practice this sport. In adolescents, weightlifting improves motor skills and promotes a healthier body composition. In older adults it helps control osteoarthritis and sarcopenia (loss of muscle mass).

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