The term pec tear is often used to refer to a rupture of the pectoralis major muscle. There is a pectoralis major muscle located on each side of the anterior chest wall (see figure 1). Ruptures can be divided into three categories (see Table 1).
|Pectoralis major muscle|
- Type I: Rupture at tendon insertion to the humeral (arm) bone.
- Type II: Rupture at the junction between the muscle and tendon.
- Type III: Rupture of the muscle belly.
Ruptures of the pectoralis major muscle were once thought to be uncommon. The majority are due to sports related injuries, most commonly weight training/lifting. (1) Such injuries have also been described in amateur wrestlers. The use of anabolic androgenic steroids (AAS) have been cited as a possible risk factor for this type of injury. (2) However, the relationship between AAS use and musculoskeletal injuries is not well understood. The little information that is available is based mostly on case reports suggesting a risk of muscle/tendon injuries. (1, 3) There are animal models showing AAS use produces a change in collagen structure that could result in alterations in tendon elasticity. This may place a tendon at risk for injury and rupture. (4,5)
Whenever a professional wrestler suffers a pectoralis major muscle injury there is a suspicion that past or current AAS use may have played a role. Such is the case with the recent pectoralis major tendon injury suffered by Matt Morgan in late July, 2011. Other wrestlers who experienced similar injuries include John Cena (right pectoralis major injury on October 1, 2007), Adam Copeland (Edge, pectoralis major injury October, 2005 and July 2007) and Jay Reso (Christian, in September 2010).
There are no studies looking at the prevalence of musculoskeletal injuries in professional wrestlers who are former or current users of AAS. There is a study involving retired professional football players who self reported AAS and musculoskeletal injuries. (6) The article is from Horn, et al. from the Department of Physical Medicine & Rehabilitation and Department of Exercise and Sports Medicine at the University of North Carolina and was published in 2009 in the American Journal of Physical Medicine and Rehabilitation.
In this study, a health questionnaire was completed by 2552 retired National Football League (NFL) players. Results of self reported AAS use and musculoskeletal injuries were analyzed. Of the retired player, 9.1% reported using AAS, with the highest use among offensive line men. There was a significant association with self reported, medically diagnosed, joint and cartilaginous injuries (disc herniations, knee ligamentous/meniscal, elbow, neck stinger, spine, and foot/toe/ankle injuries). There was no association with biceps, triceps, or shoulder dislocation/injury. Muscle/tendon injures (upper and lower) were also not more prevalent.
The authors acknowledged that limitations of the study include that it was retrospective and relied on self reported data about AAS use. The study was not able to look at the types of AAS used, dosage, duration, or frequency.
It should also be appreciated that football players may not be susceptible to the same pattern of injuries as professional wrestlers. For example, pectoralis tendon injuries typically occur in sports that require forced contractions against a resistance. This may explain the higher incidence of this particular injury in weight lifters and wrestlers.
On February 27, 2006 the WWE instituted a Talent Wellness Program that includes testing wrestlers for AAS. If AAS are a risk factor for pectoralis major muscle injuries, the number of wrestler suffering this type of injury should decrease over time.
- Knee Surg, Sports Traumatol Arthrosc 2000; 8:113.
- Am J Sports Med 20 : 587.
- Arch Orthop Trauma Surg 1993; 112: 104.
- Med Sci Sports Excerc 1991; 23:1.
- Orthop 1987; 11: 157.
- Am J Phys Med Rehabil 2009; 88(3): 192.
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