Mario Williams - pectoralis major rupture

Quick post tonight.

Mario Williams of the Houston Texans ruptured his pectoralis major (i.e. torn pectoral) against the Oakland Raiders in Week 5. He had surgery on it a few days ago to repair the injury. He will be out for the rest of the season rehabilitating.

We actually have two pectoral muscles - the pectoralis major and pectoralis minor. The pectoralis major is the one most people know about, with each one spanning half of the chest starting at the clavicle and along the sternum and inserting into humerus. Since it spans such a large area and has multiple attachments, it can perform a number of actions:

1. flexing the humerus (lifting your arm at the shoulder joint)
2. extending the humerus (lowering your arm at the shoulder joint)
3. adducting the humerus (bringing your arm closer to the midline - e.g. think of the lifting action of the bench press when you draw your elbows inward)
4. medial rotation of the humerus (turning your entire arm inwards)
5. aiding with deep inspiration

Needless to say, it can be pretty important. The pectoralis minor, on the other hand, is relatively small in comparison and actually hides underneath the pec major. It starts on the third, fourth and fifth ribs and goes to attach to the scapula (shoulder blade). It mainly acts as a stabilizer for the scapula, bringing it down and forward.

Obviously, of the two the pectoralis major is used far more often. Strangely enough, pectoralis major ruptures are relatively uncommon, possibly due to its size and strength. One source mentioned there were fewer than 100 documented cases in the past 25 years. It requires a very large load to overcome this large sheath which is why it makes sense that most of the time this type of injury occurs when weight-lifting (i.e. bench pressing) large weights. 

Williams wasn't weight lifting that Sunday but you can imagine the forces involved in football are pretty comparable.

Patients suffering from this injury usually present with marked weakness in the arm where the corresponding pec major inserts as well as extensive bruising (or ecchymycosis). 

In many non-athletic people, they can get by without surgery since they usually don't require the pec to function at 100%. Understandably, athletes usually elect to receive surgery so they can hopefully return to perform at high levels. As usual though, rehab is key. With proper physiotherapy, the athlete can usually return to pre-injury performance of the pectoralis major.