Pec Muscle Repair - UW Health

Pec Muscle Repair

The pectoralis major muscle is the large muscle in front of the upper chest. There are two parts of the pectoralis muscle, the pectoralis major and the pectoralis minor. The pectoralis major is the larger of the two and works to push the arms in front of the body like doing a push-up or bench press exercise. Pectoralis major tendon rupture is a rare shoulder injury, commonly seen in weightlifters and football players. This injury is being seen more often due to the increased emphasis on healthy lifestyles and weightlifting in older age groups. Most injuries occur as a bone-tendon avulsion injury. Surgical repair of the pectoralis major tendon rupture has been shown to provide the best outcomes for strength return, because of this surgical repair is the most common choice for those wishing to return to competitive or recreational athletic activity. Without surgery it is highly likely that the injury will cause persistent weakness, which may be acceptable for some people with more sedentary lifestyles.

Surgical repair involves using cortical buttons or suture anchors to re-approximate and attach the tendon to the bone. The pec major muscle has 2 heads, sternal and clavicular. The tendon arises from the muscular portion and then inserts near the top of the humerus (upper arm bone). This muscle functions to assist in flexion, adduction and internal rotation of the shoulder. This is important to understand because motion in the opposite direction will be limited early on in post-operative rehab.

Pec Muscle Repair

Phase I (surgery to 2 weeks after surgery)

Rehabilitation appointments Rehabilitation goals

Precautions

? Physician appointment 2 weeks after surgery ? Rehabilitation appointments begin 2 weeks of surgery ? Reduce pain and swelling in the shoulder after surgery ? Maintain active range of motion (AROM) of the elbow, wrist

and neck ? Protect healing of repaired tissues and implanted devices ? Continuous use of the sling

Suggested therapeutic exercise Cardiovascular exercise Progression criteria

? Elbow, wrist and neck AROM ? Ball squeezes

? Walking and stationary bike with sling on ? No treadmill ? 2 weeks after surgery

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Pec Muscle Repair

Phase II (begin 2 weeks after surgery)

Rehabilitation appointments

? Physician appointment 6 weeks after surgery ? Rehab appointments 1x per week

Rehabilitation goals Precautions

? Reduce pain and swelling in the shoulder after surgery ? Maintain active range of motion (AROM) of the elbow, wrist

and neck ? Protect healing of repaired tissues and implanted devices

? Use sling whenever not doing rehab. ? Passive PROM:

o Begin abduction to 30 degrees, increasing 5 degrees per week

o Begin flexion to 45 degrees, increasing 5 degrees per week

o Begin ER at the side to 5 degrees, increasing 5 degrees per week (do not exceed 30 and not in abducted positions)

Suggested therapeutic exercise

Cardiovascular exercise Progression criteria

? Elbow, wrist and neck AROM ? Ball squeezes ? Gentle PROM shoulder as described above ? Begin gentle isometrics to shoulder/arm EXCEPT pectoralis

major actions or shoulder IR, adduction and flexion ? Scapular isometric exercises ? Walking and stationary bike with sling on

No treadmill ? 6 weeks after surgery

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Pec Muscle Repair

Phase III (begin 6 weeks after surgery)

Rehabilitation appointments Rehabilitation goals

Suggested therapeutic exercises

? Rehab every 1-2 weeks

? Functional, gently progressive shoulder range of motion in all planes with full range of motion by week 12

? Progressive strengthening of the shoulder and chest ? Correct any postural dysfunction ? Begin sub maximal isometrics to pectoralis major (shoulder

IR, adduction and flexion) in a shortened position progressing to neutral muscle tendon length. Avoid isometrics in full elongated position ? Shoulder ER, abduction and extension strengthening can be initiated in ways that does not overly stretch or tension the pec major tension (should be no pain at the repair site during these exercises) ? Side lying shoulder flexion ? Scapular strengthening ? Active, active assistive and passive range of motion at the shoulder as needed ? Core strengthening

Precautions

Cardiovascular exercise Progression criteria

? Slowly begin to wean out of the sling ? External rotation range of motion limited to 45 degrees in

abducted positions ? Shoulder extension limited to 20 degress ? Avoid any horizontal abduction ? Walking and stationary bike ? No treadmill or swimming ? Avoid running and jumping because of landing impact ? 12 weeks after surgery

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Pec Muscle Repair

Phase IV (12 weeks after surgery if meeting phase 3 goals)

Rehabilitation appointments Rehabilitation goals

Suggested therapeutic exercises

Precautions

? Physician appointment 12 weeks after surgery

? Rehab every 2-3 weeks

? Normal (rated 5/5) rotator cuff strength and endurance at 90 degrees of shoulder abduction and scaption

? Advance proprioceptive and dynamic neuromuscular control retraining

? Achieve maximal shoulder external rotation (no limitations) ? Correct postural dysfunctions with work and sport specific

tasks ? Develop strength and control for movements required for

work or sport ? Progressive pectoralis strengthening, beginning with

isotonics in a shortened range, gradually progressing to eccentrics then to an increased range. ? Multi-plane shoulder active range of motion with a gradual increase in the velocity of movement while making sure to assess scapular rhythm ? Shoulder mobilization as needed ? Rotator cuff strengthening in 90 degrees of shoulder abduction and overhead (beyond 90 degrees of shoulder abduction) ? Scapular strengthening and dynamic neuromuscular control in open kinetic chain and closed kinetic chain positions ? Core and lower body strengthening ? Loaded horizontal abduction (bench press, push ups, etc) should begin and progress in a very gradual manner. Bench should include protecting the range and limiting to a maximum of 50% of pre-injury max for the first 18-22 weeks.

Cardiovascular exercise

? Walking, stationary bike and stair master

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