Pectoralis Major Repair

UCLA Department of Orthopaedic Surgery - Sports Medicine · Thomas Kremen MD

Weight-Bearing

N/A (upper extremity)

Key Restrictions

Sling at all times including sleep x 8 wks (may remove for grooming/exercise; remove for desktop work after wk 4 with arm supported); wean from sling after wk 6 in uncontrolled settings; full wean by wk 8; sling in public x 8 wks; no active use of operated UE on land x 8 wks; no WB through operated UE x 8 wks; avoid passive tension x 6 wks (no IR behind back); PROM: flexion 0-90° x 4 wks then 0-140° by wk 8; ER 0-30° x 6 wks then 0-60° by wk 8; no driving x 3 wks; no ROM behind back or cross body adduction past midline Phase 1; no pulleys Phase 1; no contact sports until 6 months post-op

Timeline & Phases

Phase 1 (day 1 - wk 8): sling at all times, no active UE on land, PROM in constraints (flex 0-90° x 4 wks → 0-140° by wk 8; ER 0-30° x 6 wks → 0-60° by wk 8), pendulum with flexed elbow cradled by non-op arm, Grade I/II mobilization for pain, aquatic therapy after 3 wks (submerged, slow motion within precautionary ROM), elbow/wrist/hand AROM | Phase 2 (wks 8-12): D/C sling by wk 8 (light use at waist only — "nothing heavier than a coffee cup"), PROM with gentle overpressure all planes toward full by wk 10, AAROM → AROM, ER at 90° abduction begins, rhythmic stabilization, aquatic therapy without ROM limits, submaximal isometrics, no pulleys until full PROM achieved | Phase 3 (month 3-6): arm at/above shoulder height with light weight, lifting ≤10 lbs below shoulder, no contact sports until 6 months; RC/pec strengthening: IR/ER theraband/hand weights 30-50 reps at low resistance, supine rhythmic stabilization progressing to reclined/upright, palm-down scaption to 90° then overhead, scapular stabilization (serratus presses/wall presses), deltoid raises to 90°, gym machines (chest press/lat pulldown/seated row) anterior to body plane, PNF diagonals, aquatic with gloves/paddle; advanced strengthening (surgeon clearance required) for overhead athletes/heavy laborers

Notes

Progression tailored to individual based on goals, age, acute vs chronic tear, tissue quality, and amount of repair tension; if concomitant biceps tenodesis/tenotomy: only PROM for elbow flexion/supination Phase 1; no pulleys Phase 1; aquatic therapy begins at 3 wks; criteria to advance to Phase 2: PROM goals achieved, minimal to no pain; criteria to advance to Phase 3: full PROM, AROM with normalized mechanics without scapular shrug, pain <2/10; RTS criteria: physician clearance, pain-free at rest, sufficient ROM/strength with normalized mechanics for activity; no contact sports until 6 months; advanced strengthening (plyoball/body blade) requires surgeon clearance and 5-/5 cuff and scapular strength; Kremen MD UCLA PatientPop practice site

Surgeon / Author

Thomas Kremen MD