Rehabilitation for pectoralis major rupture

Post-surgical rehabilitation protocol following pectoralis major tendon reinsertion

Authors:

• Renaud Guiu (sports physician)
• Roberto Purello D’Ambrosio (PRM physician)
• Charles Schlur (orthopaedic surgeon)

Distal ruptures of the pectoralis major are rare, but not exceptional, conditions. Management is usually surgical, consisting of direct reinsertion of the torn tendon onto the humerus using anchors or endobuttons. Tendon sutures and grafts are very rare.

This is therefore an isolated, superficial tendon condition, with no associated underlying joint involvement. Post-operative rehabilitation is, in most cases, straightforward, with moderate and rapidly resolving joint stiffness.

There is only one reference publication on post-operative pectoralis major rehabilitation, dating from 2007.

Few teams therefore have genuine experience with this rehabilitation, and there is little published data to safely speed up this protocol.

The basic rules of this rehabilitation are simple:

• Immobilisation: 0–6 weeks
• Rehabilitation for full recovery of joint range of motion: 6–12 weeks
• Progressive muscle strengthening: 12–24 weeks

In our experience, we have observed two risk periods for re-rupture of the reinsertion:

Immediate rupture within 48 hours after surgery: this can be related to several factors — a tendon stump that is too thin or frayed, a poor reinsertion, a reinsertion that is too muscular and not tendinous enough, a technical issue, or accidental sudden effort after surgery…

Delayed rupture around 2 months post-operatively: patients often feel too good, too quickly, and it can be tempting to speed up the return to load-bearing.

Isokinetic assessment

A specific test developed with Badr Hariri to assess pectoralis major strength during post-operative follow-up.

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Return-to-sport reconditioning

Optimal period identified: 4 to 5 months post-operatively. Referring physician: Dr Roberto Purello D’Ambrosio at the CERS in Saint-Raphaël.

Contact:

To access the pre-admission form, please click here. Please send it to the following email addresses: adm.cers.sra@ramsaysante.fr and roberto.purello-dambrosio@ramsaysante.fr.