Table 3.
Pectoralis Tendon Post-operative Protocol
| POST-OPERATIVE REHABILITATION FOLLOWING PECTORALIS TENDON REPAIR | |
| PHASE I - IMMEDIATE POST-OPERATIVE PHASE (WEEKS 0-2) | |
| Goals | Protect healing repaired tissue |
| Decrease pain and inflammation | |
| Establish limited range of motion (ROM) | |
| Exercises | No exercise until end of 2nd week |
| Sling | Sling immobilization for 2 weeks |
| Passive rest for full 2 weeks | |
| Allow soft tissue healing to begin uninterrupted | |
| Allow acute inflammatory response to run normal course | |
| PHASE II - INTERMEDIATE POST-OPERATIVE PHASE (WEEKS 3-6) | |
| Goals | Gradually increase ROM |
| Promote healing of repaired tissue | |
| Retard muscular atrophy | |
| Week 2 | Sling immobilization until 3rd week |
| Begin passive ROM per guidelines (Table 2) | |
| External rotation to 0 beginning 2nd week | |
| Increasing 5 degrees per week | |
| Forward flexion to 45 degrees | |
| Increasing 5-10 degrees per week | |
| Week 3 | Wean out of sling immobilizer - week 3 |
| Continue passive ROM per guidelines (Table 2) | |
| Begin abduction to 30 degrees | |
| Increasing 5 degrees per week | |
| Begin gentle isometrics to shoulder/arm EXCEPT pectoralis major | |
| Scapular isometric exercises | |
| End of Week 5 | Gentle submaximal isometrics to shoulder, elbow, hand, and wrist |
| Active scapular isotonic exercises | |
| Passive ROM per guidelines (Table 2) | |
| Flexion to 75 degrees | |
| Abuction to 35 degrees | |
| External rotation at 0 degrees of abduction to 15 degrees | |
| PHASE III - LATE POST-OPERATIVE PHASE (WEEKS 6-12) | |
| Goals | Maintain full ROM |
| Promote soft tissue healing | |
| Gradually increase muscle strength and endurance | |
| Week 6 | Continue passive ROM to full |
| Continue gentle sub maximal isometrics progressing to isotonics | |
| Begin sub maximal isometrics to pectoralis major in a shortened position progressing to neutral muscle tendon length. | |
| Avoid isometrics in full elongated position | |
| Week 8 | Gradually increase muscle strength and endurance |
| Upper body ergometer | |
| Progressive resistive exercises (isotonic machines) | |
| Theraband exercises | |
| PNF diagonal patterns with manual resistance | |
| May use techniques to alter incision thickening | |
| Scar mobilization techniques | |
| Ultrasound to soften scar tissue | |
| Week 12 | Full shoulder ROM |
| Shoulder flexion to 180 degrees | |
| Shoulder abuction to 180 degrees | |
| Shoulder external rotation to 105 degrees | |
| Shoulder internal rotation to 65 degrees | |
| Progress strengthening exercises | |
| Isotonic exercises with dumbbells | |
| Gentle 2-handed sub maximal plyometric drills | |
| Chest pass | |
| Side-to-side throws | |
| BodyBlade | |
| Flexbar | |
| Total arm strengthening | |
| PHASE IV - ADVANCED STRENGTHENING PHASE (WEEKS 12-16+) | |
| Goals | Full ROM and flexibility |
| Increase muscle strength and power and endurance | |
| Gradually introduce sporting activities | |
| Exercise | Continue to progress functional activities of the entire upper extremity |
| Avoid bench press motion with greater than 50% of prior 1 repetition max (RM) | |
| Gradually work up to 50% of 1 RM over next month. | |
| Stay at 50% prior 1 RM until 6 months post-operative, then progress to full slowly after 6 month time frame | |
| KEYS | Don't rush ROM |
| Don't rush strengthening | |
| Normalize arthrokinematics | |
| Utilize total arm strengthening | |