T Nation

Unhappy with My Pec Tear Repair - Pic

Injuries and Rehab
#1

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I tore my right pec doing heavy weighted dips on 5/19/14. It was a complete tear at the myotendinous junction. I had surgery on 7/1, done by an experienced shoulder surgeon for a prestigious orthopedics group in Chicago.

From early on post-surgery, the anterior fold of my armpit didn’t feel right, such as when I would put deodorant on. And at six weeks post-op, when the sling came off and I was finally able to raise my arm, I saw why that was. My armpit was webbed, a bit like it had been after my injury but before my surgery.

This picture was taken 8 weeks post-op. The picture doesn’t really do justice; it’s more noticeable in person, but you get the idea. I feel an unnatural “pulling” sensation in my armpit, although this may be related to scar tissue at the incision or muscle tension. I dislike the webbed appearance, and the feel of the very thin band of tissue that protrudes down.

So I’m wondering, does anyone else have this after a pec tear repair?

#2

I have never torn my pec, but I have torn my bicep and tricep tendons and had surgery to reattach them. In both cases, it took months (probably more like a year) for them to look and feel normal again. I don’t know if the “webbing” you are describing is something to be concerned about or not. I would discuss with the surgeon if you are really concerned. But I would suggest being patient with it. I know the new attachment points for my bicep and tricep made them look very weird, especially at first. Plus the scar tissue, atrophy, swelling, etc. all are a factor. Once you get back to working out normally and get your range of motion back, I bet it will look and feel a lot better.

#3

Talk to your surgeon about it. Also bring it up with your PT, he may be able to mobilize the scar to alleviate some of the pulling sensation.

<------------- Not an MD

#4

Thank you both for responding. I saw my surgeon for the first time since the surgery (which was on 7/1) on 9/11 (which in of itself is a red flag) and unfortunately he didn’t say much. I stated my dissatisfaction with the axillary fold, and I suspect that he is also disappointed in the results. His body language suggested that he cared, but he said only what was absolutely necessary (perhaps for fear of litigation). He said that I should go to therapy (haven’t started d/t needing out of network approval).

When I asked more directly why my axillary fold protrudes, he cited the time from my injury to my surgery made it harder to get everything in place. I replied that it was only six weeks, that my injury was in the acute phase (not chronic), and that according to the medical journal articles I had read the time from injury to surgery is not of primary importance.

A delayed surgery is a little more complicated because of more adhesions that the surgeon must free and the greater retraction of the muscle. Maybe at two years a significant challenge, but not 6 weeks. (This is discussed thoroughly in an 2010 article co-authored by Dr. X, who is one of his surgical partners and also did shoulder surgery on my cousin 2 weeks after I had mine, btw).

What bothered me most was that his physician assistant, with my surgeon present in the room, actually offered to give me referrals of other surgeons I could see about this (one being Dr. X). Presumably that was pre-arranged with my surgeon to mention that? Regardless it was very strange. I mean, if you are my doctor and you are referring me the first time you have seen me post-surgically, what is that telling me?

This doctor is a team physician/surgeon for a major Chicago baseball club, btw.

I paid $14,500 out-of-pocket for my surgery (no insurance) so the fact that I am unhappy with the result sucks even more.

I will mention all of my concerns to my PT when I get to start therapy. I’ve also been thinking that PT may free up adhesions, like you mentioned, and improve my shoulder mobility. I am afraid that some mobility deficit will persist, and I know that the cosmetic aspect of my surgery will not improve on its own.

#5

Research your PT, they’re going to have a huge influence on your outcome measures at this point. You don’t have to go to who ever your surgeon recommends (although that’s always a great place to start) and I’d stay away from the larger chains (athletico, ATI) as well as any other clinic that’s going to pass you on to a PT aid after 15 minutes.

#6

[quote]Dr. Pangloss wrote:
Research your PT, they’re going to have a huge influence on your outcome measures at this point. You don’t have to go to who ever your surgeon recommends (although that’s always a great place to start) and I’d stay away from the larger chains (athletico, ATI) as well as any other clinic that’s going to pass you on to a PT aid after 15 minutes.[/quote]

My surgeon (PA actually) recommended Athletico or ATI.

#7

That sounds like a strange situation. Good luck with everything.

As far as the time between injury and surgery, I’ve been told that every day matters. Both of my surgeons told me less than a week is ideal. Any more than that and it gets significantly more difficult. When I tore my tricep tendon, I met with the surgeon the same day and scheduled the surgery for 6 days after that and he was worried that it was too long to wait. That was one of the first things I thought of when I read your original post. I’m surprised your surgeon didn’t bring it up at your first consultation.

#8

Regarding the notion that surgery must be done ASAP after the pec tear, read these two excerpts from the same medical journal article:

“Chronic ruptures are slightly more complicated as there is
a large amount of scar tissue and adhesions to the subdermal
layers and chest wall. Once these have been incised, the ten-
don is released and mobilized, allowing the surgeon to pro-
ceed with the technique used for an acute rupture. It is
normally unnecessary to augment chronic ruptured tendons
with autografts or allografts, even later than 18 months after
injury. 57”

“Bak et al suggested there was a slight advantage to treating
a rupture surgically if the injury was less than 8 weeks old,
and while some authors agree,16,20,31,37,49,67
other authors conclude that chronicity of the injury does not affect surgical
outcome. 30,63,66”

Both basically state that time from injury to surgery is not very important. My time from injury to surgery was 6 weeks and 1 day.

One other thing I didn’t mention is that my physician did basically no informed consent at my only preop. appointment. He told me only one thing about my surgery – that my incision would be about so big (he motioned with his fingers spread apart) and superimposed his fingers over my anterior armpit/shoulder area. He told me NOTHING about risks, benefits, expected results, the procedure itself, etc. The only other things he told me were 1) I needed surgery 2) Where the surgery would be and when 3) The approximate cost (to which he underestimated by about 7 grand). Neither of his PAs gave me any information either. He was only in the room for a matter of 2-3 minutes. A medical student from U of Minnesota (intern) even took my injury history and reported to him before he came in the room. I am a registered nurse, and I know skipping informed consent is a big no-no. I can’t believe that a prominent surgeon at a major medical facility would do that.

#9

I’ve read many medical journal articles on this procedure, and one from 2012 (Metzger et al.) was most insightful regarding surgical techniques as they relate to surgical outcome. Of note:

“In younger, active patients, surgical repair is indicated, and a review of recent literature has found surgery to yield excellent functional and cosmetic results.6, 7, 8, 9, 10, 11, 12, 13, 14”

On the importance of relieving adhesions between tissue layers before performing repair:
“Inadequate mobilization of the pectoralis major muscle medially will not allow adequate excursion, resulting in postoperative stiffness and external rotation deficit.”

On the importance of proper button/anchor placement in bone:
“There is also a well-conserved musculotendinous twist proximal to the bony insertion site, with the sternal limb inserting proximal and deep to the clavicular limb.2, 3, 4, 5 Surgical repair should ideally reapproximate this anatomy to achieve optimal functional and cosmetic results.”

On the importance of using the proper tension on the repair:
“The pectoralis major tendon is anchored to the proximal humerus at its native insertion site with appropriate tensioning of the unicortical pectoralis buttons for fixation… This allows for appropriate contour and tension of the pectoralis major muscle…This is potentially advantageous from a clinical and cosmetic standpoint because it re-creates the native length-tension relation of the muscle…”

#10

You completely torn a muscle off your body. You don’t like how it looks cosmetically now. I’d be more concerned with function. I’d be grateful that I had function restored and would stop at that point. Your basically siting one surgical study as the end all be all.

The surgeon was in the room every surgery is not the same. Only the surgeon knows why the outcome came out the way it did. I’m sure there are other studies and studies. Working on the human body isn’t like working on say a car every surgery person will have there own result. Personally if I could function again and the surgery improved my situation from before I’d be happy.

#11

[quote]Ryancoburn wrote:
You completely torn a muscle off your body. You don’t like how it looks cosmetically now. I’d be more concerned with function. I’d be grateful that I had function restored and would stop at that point. Your basically siting one surgical study as the end all be all.

The surgeon was in the room every surgery is not the same. Only the surgeon knows why the outcome came out the way it did. I’m sure there are other studies and studies. Working on the human body isn’t like working on say a car every surgery person will have there own result. Personally if I could function again and the surgery improved my situation from before I’d be happy.[/quote]

I appreciate your honest opinion. I am more concerned with the functional aspects of my shoulder than the cosmetic. I will likely regain 100% of my previous strength level, but given how my shoulder looks and feels now, I’m very concerned with the mobility and feel of my shoulder in the future. Quality of function matters to me, not just the fact that he put me back together again.

I cite only that one study because that is the only study I came across that really addresses other possible influences on surgical outcome (namely surgical techniques). Everyone rehashes the same “you must get the surgery done ASAP” without ever citing any evidence or references other than “my doctor told me so.” The only journal article that I could find that reviewed or summarized the medical literature on this topic is the other article I mentioned above.

The fact that my surgeon, when questioned, was saying the absolute minimum, is very unsettling to me. I expect to have an honest and open conversation with my surgeon regarding my surgical outcome. This I did not receive.

Again, thank you very much for responding.

#12

Lawyers run medicine and drug companies take all the profits. I too think it’s a sad state that doctors have to basically protect themselves at every corner. It would be great if doctors could be open and state there honest feelings. But in the medico legal world the lawyers are king the doctors have to practice a certian way due to litigation.

I wish you the best with your rehab. I’d work into it very slowly before you start hitting the weights hard.

Having never torn a muscle do you honestly believe a surgery can make things perfect again? I’d just focus on my own limitations unless you suspect real neglect. I’d focus on recovery. I’ve seen people get hung up on the surgeon and they basically are limiting themselves.

#13

It’s not perfection that I’m seeking, but if results are typically “excellent,” then I think I should expect to look and feel pretty much normal.

I likely will contact one of the nationally renowned doctors in this surgery to get a second opinion. If nothing else, I just want to know more.

I believe a medical resident did my surgery (I met him before the surgery, and he was mentioned as the “assistant” in the surgical report - LOL), and not the doctor I hired. This ortho department was involved in a major lawsuit a few years ago in part for this very thing (the plaintiff was a surgeon on staff) but it was thrown out on a technicality.

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#15

Hi - i had my surgery recently and unfortunately i have the same outcome you did. I agree with you that it is not what i expected.
What happened since then? did it get improved? Did you muscle grow on it and covered it or is it the same thing now? i appreciate your response.
Thanks