Pectoralis Major Tendon Repair Rehabilitation Protocol

Restrictions:

  • Immobilisation of the shoulder joint in a broad arm sling for 6 weeks 24 hours per day.

  • 2 weeks of night-time only sling use in addition

  • Shoulder flexion to maximum 60 degrees, Abduction 60 degrees, external rotation to 0 degrees in the first 6 weeks post operatively

  • No direct pectoralis massage or stretches for minimum 10 weeks postoperatively

  • No heavy strength training or heavy lifting for minimum 12 weeks postoperatively

  • Gradual return to sporting activity at 4 - 6 months

 

Patients should have a grasp of exercises and use of sling and simple ADL functions prior to discharge home

Aim to get early control of shoulder girdle and interscapular muscles

Light pendular and rotation exercises within range of motion limits

Circulation exercises

Do exercises 4 - 6 x per day

Aim for a relaxed exercises to avoid tension about the shoulder and neck

 

At 2 and 6 week follow up

Wound review

Check pain levels

Observe simple ADLs

Range of motion in flexion, abduction and rotation should be measured

Check control of shoulder girdle and interscapular muscles

 

8 week follow up with Dr Mansour to check progress

 

Phase 1: 0 – 6 weeks

Goal

Focus on gentle range of motion, good circulation, and posture

Action

  • Daily active exercises. Careful pendular exercises. Active elbow flexion and extension, hand circulation exercises and scapular muscle activation

  • Passive range of motion exercises with limits: abduction 60 degrees, flexion 60 degrees and external rotation 0 degrees

  • Use of cryotherapy for pain relief and swelling reduction once sensation returns

  • Relaxation and posture exercises to reduce tension in the neck and shoulder girdle

Criteria to move to the next phase

  • Near non tender, near pain free for all movements, achieve range of motion as stipulated above (60/60/0). Scapulohumeral rhythm control.

 

Phase 2: From 6 weeks to 12 weeks post-operatively

Goals

Increase range of motion (free range of motion within pain limits), scapulohumeral rhythm control, gradual increased activation of shoulder girdle musculature

Action

  • At 6 weeks begin range of motion as tolerated for shoulder

o   focus on good quality motion

  • Scapular mobility exercises

  • From week 6 begin light isometric flexed elbow rotator cuff strength and gentle  active theraband through range exercises from week 8 - 10: Check for good scapulohumeral rhythm.

  • Can begin focused gentle joint stretching from week 12 if range of motion is not optimal.

o   Strictly avoid pectoralis stretching – if stiff in external rotation please contact

Criteria to enter phase 3

  • Over shoulder height range of motion with good quality range of motion, little or no pain, good scapulohumeral rhythm.

Phase 3: From week 12 onwards

Action

  • Loading as tolerated with graduated strength program including dynamic strength, proprioception, and stabilisation

  • Start with eccentric training for rotator cuff, and pectoralis with adding in assisted concentric exercises

  • Strength for scapulothoracic musculature

  • Move to combined dynamic proprioception and strength training

  • Stretching to continue

  • Aim for normal active and passive range of motion

  • Functional training

Criteria for moving to next phase

  • Full active range of motion. Little to no pain, good Scapulohumeral rhythm and muscular control

Phase 4

Goals

Return to work and normalise ADLs, sporting, and work practices

Action

  • ADLs, work, and sports specific training

  • Increase muscle strength, power, and stamina

  • Maintain full range of motion

o   Return to impact contact activities and bench press as a final goal of rehabilitation.

Timeframes

Approximately 4 - 6 months to regain strength and return to sport

Criteria for return to sport

  • Full range of motion. No pain with activity. Good muscular control.

  • Strength test 95% compared to uninjured side.