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Pectoralis major injuries in the military: a surveillance approach to reduce an underestimated problem
  1. Veronique D Hauschild1,
  2. TL Grier1,
  3. A Schuh-Renner1,
  4. L J Forrest2,
  5. C E Hirleman1,
  6. E Pinyan1 and
  7. B H Jones1
  1. 1US Army Public Health Center, Epidemiology and Disease Surveillance, Aberdeen Proving Ground, Maryland, USA
  2. 2Defense Health Agency, Falls Church, Virginia, USA
  1. Correspondence to Veronique D Hauschild, US Army Public Health Center for Epidemiology and Disease Surveillance, Aberdeen Proving Ground, Maryland, USA; veronique.d.hauschild.civ{at}


Introduction Multiple studies report increasing cases of surgically treated pectoralis major (PM) muscle and tendon ruptures in military populations. Studies associate this with a growing popularity of weight-training and bench press exercises. Mild-to-moderate non-surgical PM traumas and overuse injuries have not been included in these studies despite evidence that these types of outpatient injuries account for the majority of the military’s injury medical burden.

Methods To assess rates of all PM injuries (ruptures, tears, strains, overuse), regardless of form of treatment, a PM injury surveillance definition was derived from International Classification of Disease (ICD) diagnostic codes used in routine US Army injury surveillance. A detailed clinical examination of 2016 Active Duty Army medical records was used to identify ICD codes commonly associated with PM injuries. Cost data were calculated and the definition applied to medical data from 2016 through 2018to assess trends.

Results The estimated incidence of PM cases among soldiers was over 95% greater than if only considering severe surgical cases. Over 96% of army annual PM injury costs (direct medical and indirect from lost labour) were for outpatient services. PM injury incidence rates were not statistically different from 2016 to 2018.

Conclusions The PM injury surveillance definition provides a consistent means to monitor trends over time and evaluate the effectiveness of prevention efforts. PM injuries have a larger military impact than previously recognised and prioritised prevention strategies are needed to reduce them. Future interventions could focus on the bench press given its observed association with PM injuries.

  • sports medicine
  • orthopaedic & trauma surgery
  • shoulder
  • orthopaedic sports trauma
  • musculoskeletal disorders
  • epidemiology

Statistics from


  • Contributors VDH planned the study and drafted the documents; TG advised methodology and reviewed; AS-R and LJF advised on methods, conducted analyses and provided review; CEH provided clinical input and reviewed medical records; EP summarised literature review and reviewed; BHJ provided clinical and epidemiological input and reviewed.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The views expressed are those of the authors and do not necessarily reflect the official policy of the US Department of Defense, US Department of the Army, US Army Medical Department or the US Government. Use of trademarked names does not imply endorsement.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The project was approved by the investigating institution’s review board—US Army Public Health Review Board (PHRB).

  • Data availability statement No data are available. The use of data from US Army soldiers medical records is not available to public but is authorized for the performing organisation’s public health injury surveillance and prevention mission when de-identified and aggregated in public health studies.

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