Pectoralis major tears: comparison of surgical and conservative treatment.

OBJECTIVES To compare objective measures of strength and subjective functional outcomes in complete distal pectoralis major tears treated either surgically or non-surgically. METHODS Twenty two pectoralis major tears were included in 21 patients. Ten were surgically repaired and 12 were managed non-surgically. Patients completed a standard questionnaire, and clinical examination and isokinetic dynamometry were carried out. RESULTS In patients who had surgical repair, peak torque returned to 99% of that of the uninjured side and work performed returned to 97%. For those managed conservatively, peak torque and work performed returned to only 56% of that of the uninjured side (p = 0.003 for the difference in peak torque, and p = 0.01 for work performed). Findings were independent of the strength of the patient, whether or not the dominant arm was involved, the age of the patient, and the length of time from injury or surgery to testing. Patients were grouped into one of three subjective functional outcome groups, and those who had a surgical repair had a better functional outcome. CONCLUSIONS Surgical repair results in greater recovery of peak torque and work performed than conservative management of patients with rupture of the pectoralis major.