Firefighter Anthony Ramos was performing routine physical training with his squad at a Rockledge, Florida fire station, and took his turn practicing with the hoseline. Struggling with the hose, blasting water at approximately 150 pounds per square inch, he heard a loud ripping sound.
“It felt like you lost a wheel on your car and your transmission failed,” said Ramos. Wearing 60 pounds of gear, Ramos ripped his right pectoralis major muscle under the water pressure and completely detached it from the humerus bone.
Pectoralis major tears (pec tears), although rare, occur mostly in athletes performing sports-related activities. Weightlifters, wrestlers, tennis players and even football players can rip the pectoralis major from too much strain. Most common in weightlifting, pec tears can occur from the bottom of a heavy bench-press or initiation of a dumbbell chest fly. The injury is extremely painful and often rips loudly, similar to the sound of Velcro.
A pec tear is manageable and one can live with the injury, but will lose muscle function. Exercises like pushups and chest flyes become impossible, and activities involving the chest muscles become extremely difficult.
Associated pain in the shoulder and bicep pain is often common, and those injured often mistake a pec tear for a shoulder or bicep injury. The longer one goes without repairing the pectoralis major, the more the muscle belly retracts over the tear, limiting range of motion and activity.
“I couldn’t pick up my daughter and my two-month old son, let alone patients (while) on duty,” said Ramos. “It was very frustrating… all I wanted to do was play with my kids.”
Ramos was in fact, mistakenly diagnosed with a shoulder injury and even cleared to go back to work at the fire station after a few months. As he struggled to handle patients and perform his engineering duties at the fire station, Ramos took research matters into his own hands. Through internet forums and blogs, Ramos discovered Matthew Stiebel, MD, an orthopedic surgeon at Jupiter Medical Center specializing in sports medicine, with a history of more than forty pectoralis major repairs.
Only a handful of surgeons in the United States perform a large volume of pectoralis repair procedures. With an extensive background in orthopedic surgery for athletes, Dr. Stiebel handles patients from as far as Germany, Mexico and even the Netherlands. Within the first few minutes of his physical examination, Dr. Stiebel was able to diagnose Ramos’ pec tear, confirmed later by a pectoral MRI.
“I wanted to hug Dr. Stiebel for finally confirming that something was still wrong with my chest (and not my shoulder). You know when your tire on your car is flat. I knew something wasn’t right. I was so fortunate to find Dr. Stiebel in South Florida. The next closest doctor I found was in Puerto Rico!” said Ramos.
Matthew Stiebel, MD, FRCSC, completed an orthopedic surgery residency at McGill University and a subspecialty fellowship in sports medicine at Boston University after undergraduate and medical school degrees at Yale University. His specialties include complex shoulder and knee injuries, and the repair of pectoralis major muscle tears and their subsequent outcomes. Dr. Stiebel learned this pec repair technique from Anthony Schepsis, MD, the surgeon credited with developing the technique.
“I have to mobilize and free up the whole muscle. I put heavy sutures through the muscle in a special kind of weave, designed by Dr. Skeptis,” explained Dr. Stiebel. “I make a trough or a cavity in the proximal humerus and drill holes in the lateral side of it. Then, I pull the muscle into the trough I’ve created, pull the sutures out of the holes I make in the bone and tie them over a bone bridge. The trick is to mobilize the muscle and free it away from all the adhesions to make sure the nerves around it are okay. To get a good repair the muscle has to go to the bone. You can’t repair the muscle back to the tendon.”
A pec tear patient is generally kept overnight in the hospital following surgery, and wears a sling from four to six months before beginning rehab. They can begin strengthening the pectoral major as early as three months and can go back to weightlifting or sports around six months. Patients regain an average of 90-95 percent strength back in the pectoral muscle after having the surgery.
Ramos was just cleared to go back to work as a fulltime firefighter a few months after his pec repair procedure. “I can’t say enough good things about Dr. Stiebel and my pec surgery. I had an amazing experience at Jupiter Medical Center. I was nervous about having such major surgery, but my injury was affecting my very livelihood. I just wanted to pick up my kids again.”
Jupiter Medical Center is proud to offer the pectoralis repair procedure to patients. Jupiter Medical Center remains on the leading edge of orthopedics, offering highly-skilled orthopedic surgeons, state-of-the-art facilities, and comprehensive rehabilitation services to help patients return to an active and healthy lifestyle. The Anderson Family Orthopedic and Spine Center has earned The Joint Commission’s Gold Seal of Approval for its total knee, total shoulder and total hip replacement program.
To learn more about Jupiter Medical Center’s Orthopedic Center of Excellence, call Judy Dellosa, RN, ONC, Orthopedic Clinical Coordinator, at (561) 263-3633 or visit www.jupitermed.com/ortho.