Split Pectoralis Major Transfer for Chronic Medial Scapular Winging

Abstract

Scapular winging can be a significant source of chronic pain, weakness, and disability of the shoulder. Isolated serratus anterior palsy from long thoracic nerve injury, which is the most common cause of this condition, produces prominent winging and medial malpositioning of the inferior angle of the scapula. In the case of persistent symptoms despite conservative care, treatment options primarily include scapulothoracic fusion and pectoralis major transfer. Outcomes of scapulothoracic fusion are notable for a high complication rate and limited functional improvements. We describe our technique of indirect, split pectoralis major transfer to the inferolateral scapula with allograft tissue augmentation for the surgical treatment of chronic medial winging. This procedure provides dynamic stabilization of the scapula with secure and tension-free tendon transfer. Advantages over alternative treatments include a relatively low complication rate, acceptable cosmesis, and better range of motion. The rationale and technical aspects of this procedure are discussed. Additional clinical studies are warranted to compare outcomes for the direct and indirect split transfer methods.

Surgical management of bilateral scapular winging in a previously healthy 10-year-old boy: A case report

“…There are multiple techniques available for this procedure, with little evidence to support one over the other [ 15 ]. Most patients undergoing this procedure have regained full range of motion upon recovery [ 16 ], most frequent reported complications for this operation is transfer failure, infection, unsatisfactory cosmetic result, glenohumeral stiffness [ 17 ].…”

Complex Shoulder Girdle Stabilization Using Allograft Capsular Reconstruction and Pectoralis Major Transfer

“…To our knowledge, this is the first report on surgical technique describing a combined soft-tissue rebalancing of intractable anterior shoulder instability with associated scapular winging. The combination of reconstructive techniques 19,21,23 , previously reported as individual treatment options, was necessary given her complex injury pattern. Although successful at the 2-year follow-up, larger case series and longer-termed studies will better validate the outcomes observed in this case report.…”

Which Components of the Simple Shoulder Test Show Improvement After Scapulothoracic Fusion for Recalcitrant Scapular Winging? Clinical Results at a Minimum of 5 Years of Follow-up

“…In patients with nerve palsy of the long thoracic, spinal accessory, or dorsal scapular nerves or combined nerve injuries from Parsonage-Turner syndrome (acute brachial plexus neuritis), a prolonged course of nonoperative management allows time for nerve recovery. In patients who do not improve with nonsurgical management, a variety of soft tissue procedures can be considered, such as split pectoralis major transfer for long thoracic nerve palsy and the Eden-Lange or triple tendon transfer for spinal accessory nerve palsy [3,4,6,11]. However, some patients have persistent symptoms despite these soft tissue procedures, and some are not appropriate candidates for them (such as patients with brachial plexus palsy affecting multiple nerve roots that supply the pectoralis major, rhomboids, or levator scapulae).…”