Acute Pectoralis Major Tears in Forward Deployed Active Duty U.S. Military Personnel: A Population at Risk?

Introduction: As sport related activities and weight training broaden in popularity, the incidence of pectoralis major tears appears to be increasing. The purpose of our study is to report on the causes of a series of acute pectoralis major tears in active duty deployed military personnel; identify any patient specific risk factors and to confirm that in-theater surgical repair is possible in most cases. Methods: Retrospective analysis of the medical records and imaging of 9 cases of acute pectoralis major tears evaluated and treated by the deployed military orthopedic surgeons at one expeditionary medical treatment facility (MTF) over a 4 month deployment cycle from December 2013 through March 2014 was performed. Results: Nine male patients (5 USAF, USA 4) were diagnosed with pectoralis major tears; 7 complete tears at the tendinous insertion (Tietjen Type III-D), 1 complete tear at the musculotendinous junction (Tietjen Type III-C) and 1 incomplete tear (Tietjen Type II) with a mean age of 32 years (23-52). All injuries occurred during bench press with a mean weight of 258 lbs (135-415 lbs), with the dominant upper extremity involved 56% of the time. Mean length of deployment was 230 days (120-365), with injury occurring an average of 77 days into the tour (3-198 days). Mean time from injury to surgical repair in the cohort was 18 days (10-43). Conclusion: Due to the alarming frequency with which pectoralis major ruptures were diagnosed and treated at one expeditionary military treatment facility over a short four-month deployment cycle; combat deployed active duty US military personnel likely represent a high-risk population for this injury. Surgical repair with a trough and transosseous repair technique is possible in the forward deployed setting and may be considered on a case-by-case basis.