Arthroscopic release of the pectoralis minor tendon from the coracoid for pectoralis minor syndrome

Abstract

Purpose The term “pectoralis minor syndrome” refers to this constellation of symptoms that can occur when the pectoralis minor (Pm) is shortened and contracted. Release of the tendon of the Pm from the coracoid has been reported to provide substantial clinical improvement to patients presenting with pectoralis minor syndrome. The purpose of this study was (1) to describe the technique for endoscopic release of pectoralis minor tendon at the subdeltoid space, (2) to classify the pectoralis minor syndrome according to its severity and (3) and to report the short-term outcomes of this procedure in a consecutive series of patients diagnosed with pectoralis minor syndrome. Methods Endoscopic release of the pectoralis minor tendon was performed in a series of 10 patients presenting with pectoralis minor syndrome. There were six females and four males with a median age at the time of surgery of 42 (range from 20 to 58) years. Four shoulders were categorized as grade I (scapular dyskinesis), and six as grade II (intermittent brachial plexopathy). Shoulders were evaluated for pain, motion, satisfaction, subjective shoulder value (SSV), quick-DASH, ASES score, and complications. The mean follow-up time was 19 (range, 6 to 49) months. Results Arthroscopic release of the tendon of the Pm led to substantial resolution of pectoralis minor syndrome symptoms in all but one shoulder, which was considered a failure. Preoperatively, the median VAS for pain was 8.5 (range, 7–10) and the mean SSV was 20% (range, 10% - 50%). At most recent follow-up the mean VAS for pain was 1 (range, 0–6) and the mean SSV 80% (range, 50% - 90%). Before surgery, mean ASES and quick-DASH scores were 19.1 (range, 10–41.6) and 83.1 (range, 71 and 95.5) points respectively. At most recent follow-up, mean ASES and quick-DASH scores were 80.1 (range, 40–100) and 19.3 (range, 2.3–68) points respectively. No surgical complications occurred in any of the shoulder included in this study. Conclusions Endoscopic release of the tendon of the pectoralis minor from the coracoid improves pain, function and patient reported outcomes in the majority of patients presenting with the diagnosis of isolated pectoralis minor syndrome.

Arthroscopic Pectoralis Minor Release After Reverse Shoulder Arthroplasty

“…If patients fail this protocol, as in this case report, then surgical options are considered. Although traditionally open treatments focusing on first rib resection and scalenectomy were the standard of care 9,10 , many have started using minimally invasive approaches targeting the pectoralis minor and infraclavicular space 7,11 . As seen in this case, once the diagnosis of nTOS has been established, arthroscopic pectoralis minor release, suprascapular nerve release, and brachial plexus neurolysis combined with a 3-month dedicated scapular rehabilitation program (Appendix 2) can lead to marked improvements in shoulder pain, function, and patient-reported outcome measures.…”

“…Yin et al 10 found variations in the complication rates between first rib resection and supraclavicular release without resection, reporting a 10% to 13% increase when rib resection was performed. Alternatively, isolated pectoralis minor release has been shown to have promising results when performed through open 6,[22][23][24] and arthroscopic techniques 7,11,25,26 . Furthermore, a comparative series suggested it to be superior when performed alone than in combination with first rib resection 6 .…”

“…Surgery is indicated if the patient fails to improve after comprehensive scapular-focused physical therapy and home exercises. Although traditionally treated with open first rib resection 9,10 , advances in the understanding and treatment options for nTOS have led to minimally invasive arthroscopic and endoscopic options 7,11 . We present a case of a patient who had radiating shoulder and neck pain in the setting of an irreparable rotator cuff tear, that reverse shoulder arthroplasty (RSA) and an anterior cervical diskectomy and fusion (ACDF) procedure failed to treat.…”

“…In TOS, there are 3 distinct areas of neurovascular compromise, including the interscalene triangle, costoclavicular space, and the retropectoralis minor space 4,5 . One of the possible causes underlying the pathophysiology of neurogenic TOS (nTOS) involves pectoralis minor hyperactivity, starting a progressive cycle of muscle shortening leading to scapular protraction and distal displacement 6,7 . The ensuing reduction in the retropectoralis minor space and scapulothoracic dyskinesis cause the irritation of the brachial plexus and suprascapular nerve responsible for this condition 1,6 .…”

Novel Diagnostic and Treatment Techniques for Neurogenic Thoracic Outlet Syndrome

“…Another international multicenter study demonstrated similarly good improvements without any major complications. 61 Ultimately, these data highlight the large variability in open treatment for NTOS, with overall unreliable outcomes compared to VTOS. The literature regarding arthroscopic management is currently modest but demonstrates initial promise as a relatively safe and reliable technique in treating this condition.…”