Pectoralis major tendon avulsion from rappelling.

To our knowledge, we are reporting the first case of a pectoralis major tendon avulsion from rappelling. The mechanism of injury in this case differs biomechanically from the commonly associated activity of bench pressing. The patient's initial presentation, course of corrective treatment, and postoperative rehabilitation is discussed in detail. A review of the historical and current literature on pectoralis major tendon injuries is included. The results of current biomechanical studies are discussed in relation to the complex anatomy of the pectoralis major muscle. This report is relevant to individuals involved in rappelling, high-demand athletes, and the surgeons who treat them. Nonoperative management of pectoralis major tendon tears is contrasted with operative repair. The current literature supports operative treatment in high-demand athletes, laborers, and military personnel to allow them to regain full strength and endurance.