- Anaesthetic
- General
- Duration
- 60–90 minutes
- Stay
- Day surgery or overnight
- Sling
- 3–6 weeks
- Driving
- ~6 weeks
- Heavy lifting / sport
- 12 weeks
What it is.
Pectoralis major repair is the surgical reattachment of the torn pectoralis major tendon to its insertion on the humerus. The pectoralis major is the large chest muscle responsible for pushing, pressing and internally rotating the shoulder. The tendon most commonly tears where it inserts onto the upper arm bone - a complete avulsion that does not heal on its own.
Why it is done.
Complete pec major tendon avulsions in active individuals are best treated with surgical repair. Without surgery, patients lose significant strength in pressing and pushing movements, and the altered muscle contour can be cosmetically noticeable. Partial tears and muscle-belly injuries may be managed without surgery, but a complete tendon avulsion in someone who wants to return to full strength is a clear surgical indication.
The injury typically occurs during heavy bench press or similar eccentric loading with the shoulder in an extended, externally rotated position. It can also result from contact sport, falls, or heavy manual work.
How it is performed.
The procedure is performed under general anaesthetic. An incision is made in the axillary fold (front of the armpit). The torn tendon is identified, mobilised and any scar tissue is cleared. The anatomical footprint on the humerus is prepared, and the tendon is reattached using suture anchors or cortical button fixation.
Early repair (within the first few weeks of injury) generally produces the best outcomes because the tendon has not yet retracted or scarred. Chronic tears can still be repaired but may require more extensive mobilisation or tendon reconstruction if retraction is significant.
Rehabilitation protocol.
A written copy of this protocol is provided to your physiotherapist. The sling type is a Don Joy Aircast or Blue sling, worn for 3 to 6 weeks. Physiotherapy begins within 2 weeks of surgery.
Phase 1 - weeks 0–3 (protection)
- Sling worn for a minimum of 3 weeks.
- Passive range of motion for the neck, elbow, wrist and hand.
- Assisted active range of motion (AAROM) within safe zones only.
- Dynamic scapula control exercises.
- Early kinetic chain work excluding the affected arm.
- No forcing or stretching of the repair.
Phase 2 - weeks 3–6 (early mobilisation)
- Wean from sling as comfort allows.
- Gentle isometric exercises in neutral position.
- Short-lever open-chain exercises.
- Dynamic scapula control progressed.
- Light proprioceptive exercises.
- Progress kinetic chain work.
Phase 3 - week 6 onwards (strengthening and return to activity)
- Full active range of motion in all planes.
- Scapula and rotator cuff control exercises.
- Progressive strengthening with resistance.
- Full kinetic chain integration.
Milestones
- 6 weeks: Full passive range of motion in safe zones. Light lifting for daily activities. Sedentary work, driving, and non-contact sport (golf, breaststroke swimming) permitted. Gradual return to manual work (no heavy lifting).
- 12 weeks: Full active range of motion. Contact sport and heavy lifting permitted.
View the recovery roadmap for the full rehabilitation journey, or visit For Physiotherapists for protocol requests.
Frequently asked questions.
How long does it take to recover from pec major repair?
The sling is worn for 3 to 6 weeks. Light activities of daily living resume around 6 weeks. Return to contact sport and heavy lifting is typically at 12 weeks.
How does the pectoralis major tendon tear?
Most tears occur during heavy bench press or similar eccentric loading of the shoulder in an extended, externally rotated position. The tendon avulses from its insertion on the humerus.
Do all pec major tears need surgery?
Not all. Partial tears and muscle-belly tears may be managed non-operatively. Complete tendon avulsions in active individuals are best treated with surgical repair to restore strength and cosmesis.
When should pec major repair be performed?
Early repair (within the first few weeks) generally produces the best outcomes. Chronic tears can still be repaired but may require tendon reconstruction if the tissue has retracted significantly.
Will I regain full strength after pec major repair?
Most patients recover excellent strength after surgical repair. Return to pre-injury bench press and contact sport levels is expected by 12 weeks, though maximum strength may continue to improve for several months.
References.
- Bak K, et al. Rupture of the pectoralis major: a meta-analysis of 112 cases. Knee Surg Sports Traumatol Arthrosc. 2000;8(2):113–119.
- ElMaraghy AW, Devereaux MW. A systematic review and comprehensive classification of pectoralis major tears. J Shoulder Elbow Surg. 2012;21(3):412–422.