Tendon Transfer — Rotator Cuff Repair with Pectoralis Major Tendon Transfer (Open)

University of Virginia Orthopaedic Surgery

Weight-Bearing

NWB surgical UE

Key Restrictions

Sling at all times 0-6 weeks; no AROM of shoulder for first 6 weeks; no pendulum exercises weeks 1-4; PROM limited to 90° FF and neutral IR/ER in first 4 weeks; must elevate arm without scapular hiking before initiating isotonics; avoid isometric with pec in lengthened position; no lifting/overhead/repetitive shoulder motions

Timeline & Phases

Phase I (0-6 wks): sling, no AROM, no pendulums wks 1-4, PROM (FF 90° then full wks 4-6, IR/ER neutral then 45° in scapular plane), AAROM at wk 5, peri-scapular exercises, sub-max deltoid/IR/ER isometrics at wk 5; Phase II (6-10 wks): discontinue sling, PROM to full, AAROM/AROM (wand), full AROM by wk 10, peri-scapular progress, isometrics (avoid pec in lengthened position); Phase III (10-14 wks): maintain full AROM, UBE, isotonic dumbbells, PNF diagonals, prone rowing/horizontal abd/"full can", submaximal plyometrics (chest pass, side throws, body blade); Phase IV (14+ wks): full AROM, progressive strengthening/power, advanced plyometrics, sport/work-specific

Notes

No pendulum exercises weeks 1-4 (unusual); no AROM for first 6 weeks; PROM limited to 90° FF and neutral IR/ER in first 4 weeks; avoid isometric with pec in lengthened position; submaximal 2-handed plyometrics begin Phase 3 (10-14 weeks); open rotator cuff repair combined with pec major tendon transfer for massive/irreparable RC tears; 4 phases

Published

12/2024