Post-Operative Instructions: Pectoralis Major Repair

Pain Medications

  • In most cases local or regional nerve blocks will provide 8-12 hours of numbness. As soon as you start to feel the numbness wearing off, begin taking oral pain medication.

  • Take Tylenol 500mg one tab every 8 hours.

  • Take Aleve (Naproxen) 220mg two tabs (440mg total) every 12 hours with food.

  • If you still have pain after Tylenol and Aleve/Naproxen, take one Norco tab (5mg/325mg).

  • If you still have pain after all of the above, take a second Norco tab.

  • Keep in mind Norco has Tylenol in it (325mg). If you take an extra Norco, then skip a dose of Tylenol.DO NOT exceed 3500mg of Tylenol over 24 hours. 

  • It is illegal to drive or operate machinery with narcotic medications. 

  • Do not combine alcohol or other sedatives with narcotic medications.

  • You do not need to take pain medications once you no longer have pain. You should stop the Norco first (usually 2-3 days), then wean off the others over the next week or two.

Other Medications

  • Take Zofran as needed for nausea (usually associated with anesthesia/narcotic meds).

  • Take an over-the-counter stool softener (Docusate/Senna/Miralax) as needed for constipation.

Activity

  • You may NOT bear any weight on or lift anything with your operative extremity.

  • Do NOT lift your arm on its own.

  • Elevate your operative extremity above the heart as much as possible to decrease swelling.

Recovery Equipment

  • You should wear the sling at all times day and night.

  • You may remove the sling for hygiene, but the arm needs to be supported. 

Cold Therapy

  • We recommend cold therapy use as much as possible in the first two weeks. 

  • Cold therapy units may be used continuously as instructed.

  • Ice packs should be applied 30 minutes at a time, with 30 minutes off between applications.

  • Do not apply ice directly to the skin to avoid burning.

Recovery Exercises

  • You may perform elbow, wrist, and hand exercises as tolerated.

  • You will begin physical therapy around two weeks after surgery, after your first postoperative visit.

Diet: Please refer to your preoperative packet instructions.

Incision Care: Please refer to your preoperative packet instructions.

Emergencies: Please refer to your preoperative packet instructions.

Post-Operative Rehabilitation: Pectoralis Major Repair

Therapy Plan: Twice per week for 0-3 months, once per week for 3-6 months

ROM Progression

Sling at all times for 0-2 weeks

Progress passive ROM weeks 2-6 as tolerated EXCEPT no extension, limited external rotation to 30 degrees

Progress passive and active-assist ROM weeks 6-12 as tolerated without limitation

Strength Progression

Initially NO strengthening exercises for the pectoralis for 0-6 weeks after surgery

  • Start isometric strengthening at 6 weeks

  • Progress strengthening against gravity starting at 9 weeks

  • Advance strengthening as tolerated after 12 weeks

Initial Post-Operative Physical Therapy Visit (2 weeks)

  • Correctly remove and replace sling with passive motion on the operative side only

  • Instruct on elbow, wrist, and hand exercises

  • Isometric exercises for core

Phase 1 Physical Therapy (0-6 weeks): protect the joint, progress motion

  • NO open-chain exercises

  • Manual therapy 20+ minutes per session

  • Soft tissue mobilization, core strengthening

  • Sling at all times

  • Progress passive ROM as above with NO extension, limited external rotation to 30 degrees

Phase 2 Physical Therapy (6-12 weeks): progressive strengthening

  • Wean out of sling when demonstrating adequate upper extremity control and proprioception

  • Passive and active-assist ROM as tolerated with the goal of symmetric, full motion at 8-10 weeks

  • Initiate core isometric strengthening

  • Proprioceptive training

  • Soft tissue mobilization, isometric exercises, core strengthening

Phase 3 Physical Therapy (12-24 weeks): return to pre-injury level and sport

  • Focus on functional exercises in all planes, advance only when fully controlled

  • Advance closed-chain and core strengthening

  • Proprioceptive training

  • Full return may take 4-6 months or more