Pec Major Repair

Download this rehabilitation protocol (PDF)

For patients and physiotherapists.

Week 0-2

Aims:

• Pain control
• Protect the tendon repair
• Allow the wounds to heal
• Maintain overall mobility
• Axilla/armpit hygiene

Suggested treatment:

• Ice
• Regular pain relief
• Elbow/wrist/hand and neck ROM exercises
• Sling most of the time, off for hygiene

Restrictions:

• Maintain arm in sling
• No lifting objects
• No active abduction/forward elevation/ER

Week 2-6

Aims:

• Protect the tendon repair
• Scapular control/stabilisation
• Minimal pain
• Return to light work/desk duties
• Functional activities at waist height
• Sling on for majority of the time (except when doing exercises)

Suggested treatment:

• Begin passive; graduated to active assisted ROM with aim to achieve:
• Forward elevation 90°
• ER to 0° in adduction
• Abduction to 60° in neutral rotation
• Maintain overall mobility

Restrictions:

• No passive ER beyond 20°
• No strengthening exercises

Week 6-12

Aims:

• Restore full range of motion
• Shoulder strengthening
• Scapular control

Suggested treatment:

• Full active and passive ROM
• Rotator cuff and periscapular strengthening
• commence strength training – 3/12 earliest
• patient specific exercises to return to activity/sport

Restrictions:

• No heavy lifting or strengthening

Month 3-6

Aim:

• Regain full ROM
• Introduce sport specific movement

Suggested Treatment:

• Strengthening
• Introduce muscular endurance with light weight and repetition

Restrictions:

• Return to sporting activities when :
• Full non-painful ROM
• Satisfactory stability
• Satisfactory strength (isokinetics)

Some General Questions

What to expect after surgery:

• Most patients will stay a night post operatively
• After you wake up, you may notice your whole arm feels numb from the local anaesthetic applied to the nerves of your arm – this should wear off approximately 12 hours after surgery
• The next morning, you will be seen by the medical team and physiotherapists prior to your discharge
• You will be sent home with medications or a script to help with pain relief

Time in Sling:

• Generally your sling should be on at all times (except for hygiene) in the first 6 weeks
• After 6 weeks, you can wean out of the sling gradually using it less and less each day. You do not need to use your sling at night/sleeping

Return to Activity

• Driving: when adequate range of motion and pain to allow safe control of the car and to react appropriately in an emergency. Both arms must be fully functional and on the wheel for this to occur. Usually dependent on time in sling so minimum 6 weeks.
  Return to driving from 6 weeks post op at earliest
• Work: desk based roles should be able to return once pain has settled – usually approximately 2 weeks after surgery. Those with more manual occupations may need specific recommendations and light duties are usually recommended

Criteria for Return to Sports:

There are many ways to assess whether an athlete is ready to return to sport. There are also lots of variables such as the type of overhead activity (eg throwing vs swimming) and contact vs non contact sports. In the literature, “time” is the most important factor, although not the only one. Generally 6 months is the earliest possible time for return to any sport, and 9 months for contact athletes.
Other variables to consider include comparison to the contralateral side for:

• Baseline strength >80% (eg weights lifted vs pre-injury)
• <20% reduction in ROM
• Psychological readiness for overhead activity

Sports Specific Recommendations:

• Gym: pec and chest specific exercises should not be commenced till earliest 3 months. Start at minimal weight and gradually increase the load. Chest flies should be avoided till 6 months.
• Swimming: water based exercise is very helpful after surgery. No swimming until the wounds have healed – usually 2 weeks post operatively. Breaststroke by 12 weeks and freestyle by 18 weeks.
• Golf: usually requires significant rehab and time before adequate protection of the stabilisation has occurred. Usually 4-6 months post op
• Non Contact Sports: or sports where patients have control of their arm/body and can minimise the chances of a fall onto their arm with body weight (pilates, yoga, swimming, running, cycling, racquet sports, gymnastics, fencing, rock climbing)
  Consider breaking down these sports into components and commence gradual return with increasing progression of difficulty from 6 months
• Contact sports: (eg hockey, football, rugby, martial arts, BMX riding)
  As with non contact sports but with increased force and impact – need to train for unexpected impacts and ability to respond
  Do not commence before 9 months

Concerns or questions?

If you have any concerns post operatively, or you would like further information, please contact Mr Lau through the VBJS on 03 5752 5020 or via email at admin@vbjs.com.au

If you need urgent medical help, call 000 or go to your nearest emergency department.

These notes have been prepared by Mr Simon Lau. They are general overviews and information aimed for use by his patients. They reflect Mr Lau’s views, opinions and recommendations. They do not constitute medical advice. The contents are provided for information and education purposes only. Please seek Mr Lau’s specific advice with any questions regarding medical conditions and treatment.