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Shoulder Injuries in the Gym: Pec Injuries

pec injury are common at the gym

Mr Dan Rossouw discusses what symptoms to look out for when suffering from a pec injury and what treatment options there are.

New Year is here and we all know what that means: New Year’s resolution of getting fit at the gym. Unfortunately, that does mean injuries for some – including pec injuries.

Pectoralis Major injuries are one of the commonest shoulder girdle injuries I see needing my surgical attention. Although the P.Major is a big muscle, it can be injured by some seemingly minor activities.

The ‘pec’ is made up of two muscles, originating from the Clavicle (collarbone), and from the Sternum (breastbone). These two portions become flattened tendons as they near the humerus, twist partially around each other and the join onto the top part of the humerus.

If you grip the front portion of your armpit, the pec is between your fingers. A useful test to check the muscle is to stand with your hands on your hips and try to squeeze your hands towards each other. This is a manoeuvre used by competing athletes to ‘show’ their muscles, but can also tell if the muscle has been injured. Check it out in front of the hall mirror when no one is watching!

How can the Pecs be injured?

The fleshy part of the muscle can tear, much like a hamstring tear. As pec injuries go, this is good news as it can heal with rest and a bit of rehab. Unfortunately, this is the less frequent pattern of injury. More commonly, the injured area is the muscle attached to the bone – a more difficult problem altogether.

The sequence of unhappy events that occurs is usually an unexpected or overwhelming load applied to the already strained arm and the muscle fails at the weakest point – the bony attachment. This can be because of an over-enthusiastic bench press, or the incorrect placement of the weights by the assistant causing a large weight to be applied to the arm.

What do I do if the worst happens?

If pec injuries result in detachment from the bone then it has to be reattachment – only can be done via surgery I’m afraid – no rest or rehab will help in this injury. Also, the muscle bunches up to form a rounded ball shape under the skin, pretty much like a bad boob job! Worse still, it twitches when you use your arm. Not surprisingly, most inured fold seek help to get it reattached.

How is this done, and what does it mean for you?

This is not a keyhole job, but needs an ‘open’ operation with a cut in the top of the arm, about 5-8cm long. After the pec injury, the muscle will retract and bunch up, a situation that can become fixed and non-repairable within a few weeks!

Good advice is to get these injuries dealt with very quickly, preferably within days if you want a successful outcome. Waiting too long can cause such severe muscle scars that repair is not possible.

The tendons are repaired to the bone quite firmly by using small tacks or anchors, but still then must heal to the bone by scarring before normal service can resume. This process needs to be nurtured, given time and respected; otherwise it will fail.
It’s a slow cook recipe rather than a fast roast but the rewards are a much better long-term result. Often, the function can be entirely normal after 3-6 months, with only a scar to remind you of your ‘misadventure’. Your surgeon and therapist will want to keep you reigned in until they are confident the repair is strong.


Remember, using oral or injected steroids significantly weakens tendons and will predispose to this sort of injury. My advice, Say ‘no’ to steroids!

Happy training!

Mr Dan Rossouw

Mr Rossouw has a keen interest in shoulder surgery and the management of shoulder conditions, including rotator cuff injuries, shoulder instability and shoulder dislocations. He has undertaken extensive research on rotator cuff repair and shoulder arthroscopy. He is an enthusiastic and highly regarded trainer amongst his colleagues. Mr Rossouw is a Consultant Orthopaedic Surgeon for Barnet and Chase Farm Hospital and has joined the Orthopaedic faculty of the Royal Free London NHS Foundation Trust.

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