Nathan WM. Skelley, M.D.

Precautions: Until 12 weeks post-op, NO AROM; No contact sports or bench press until at least 6 months post- op.

​

Phase I (0 – 6 weeks post-op)

•  Goals: Pain control and protection

•  Sling:

        o 0-2 weeks: Worn continuously except for hygiene & HEP

        o 2-6 weeks: Worn daytime only

• ROM:

        o 0-3 weeks: Elbow, wrist, and hand AROM with shoulder in neutral position at side

        o 3-6 weeks:

        Begin PROM as follows:

        Flexion - 90
        ER - 45
        Extension - 20 Abduction - 45

• Exercises:

        o 0-2 weeks: Elbow/wrist, grip strengthening
        o 2-6 weeks: PROM as above, Pendulums, Posterior capsule mobilizations, *avoid stretching the anterior capsule

 

Phase II (6 weeks – 12 weeks post-op)

• Sling: Discharge at 6 weeks

• ROM:

  o PROM to tolerance o Begin A/AAROM
  o Goals:

  ER – full
  Flexion – 135
  Abduction - 120

• Exercises:

       Continue with wrist/elbow AROM & grip strengthening
       Begin AAOM exercises
       Initiate closed chain scapular exercises
       Begin resistive exercises for scapular stabilizers, biceps, triceps, & rotator cuff

       Use exercise arcs that protect the anterior capsule

       Keep all strengthening exercises below the horizontal plane o At 8 weeks, begin deltoid & rotator cuff isometrics
       o NO resisted IR/adduction

 

Phase III (12 weeks – 16 weeks post-op)

• Sling: None. Discharge at 6 weeks post-op

• ROM: Gradual return to full AROM 

• Exercises:

       o Advance exercises from phase II
       o Begin UBE
       o Emphasize ER & lat eccentrics and GH stabilization o At 12 weeks, begin cycling & running
       o At 16 weeks, begin planks & push-ups

 

Phase IV (4 months – 5 months post-op)

• ROM:

       o Full & pain-free ROM

• Exercises:

       o Aggressive scapular stabilization & eccentric strengthening o Begin plyometric & throwing/racquet program
       o Continue endurance activities
       o Maintain ROM & flexibility

 

Phase V (5 months – 7 months post-op)

Full ROM & pain-free 

• Exercises:

   o Progress phase IV activities
   o Return to full activities as tolerated & per physician release

 

References:

1.  Pectoralis major repair. William Beaumont Army Medical Center. El Paso, TX: 2008.

2.  Brian Cole, MD, MBA Pec Major Tendon Repair/Rehabilitation Protocol. Midwest Orthopedics at

   Rush Chicago.