Pectoralis Major to Scapula Transfer for Patients With Serratus Anterior Palsy

Abstract

Serratus anterior palsy can be a very disabling condition. However, not much has been written about many other upper limb palsies and the surgical approaches for them. In contrast, not much has been published about this particular muscle palsy. Most investigators engaged in the treatment of peripheral nerve palsies are focused on the restoration of elbow flexion/extension and shoulder abduction/external rotation. Nevertheless, scapulothoracic stability is of utmost importance for shoulder function inasmuch as it offers a stable base for arm motion--mostly forward flexion. As a result, serratus anterior palsy leads to loss of strength, range of motion, and pain due to fatigue of synergistic muscles--an issue disabling enough to warrant surgical intervention. Many investigators have suggested a variety of techniques including muscle transfers, fascial slings, or scapulothoracic fusion. The last option leads to obvious limitations in the final range of motion and should be avoided in young high-demand patients. Fascial slings have a tendency to attenuate over time.

Scapulothoracic Fusion With Nonmetallic Cables

“…19 Scapulopexy has been commonly performed in setting of FSHD or isolated nerve palsy, [3][4][5] however; there are no reports of its use in patients with spinal cord injury. This feature makes the procedure more applicable to the patients with a global upper extremity weakness pattern such as that seen in spinal cord injury.…”

“…[3][4][5] Although the reported results are satisfactory, the indication for muscle transfer procedures is limited to serratus anterior and trapezius palsy. [3][4][5] Although the reported results are satisfactory, the indication for muscle transfer procedures is limited to serratus anterior and trapezius palsy.…”

Outcome of arthroscopic pectoralis minor release and scapulopexy for the management of scapulothoracic abnormal motion

“…3,12,15 Initial management of patients with STAM focuses on nonoperative treatment and physical therapy to improve scapular control and balance, strengthen the scapular stabilizing muscles, and activate the rotator cuff. 2,4,5,16,18,19 In patients with persistent scapular dysfunction and pain despite structured physical therapy, surgical treatment can be considered. Various surgical treatments have been reported in the management of recalcitrant.…”

Pectoralis Major Muscle Transfer With the Sternal Head and Hamstring Autograft for Scapular Winging

“…These approaches, however, are limited due to their complication profile, specifically their tendency to either loosen over time or cause functional impairment and subsequent pulmonary complication or nonunion, respectively. 1 , 3 , 4 These limitations have thus led to the use of tendon transfers to address scapular winging and restore normal scapulothoracic motion. 5 …”