Surgical Technique and Anatomic Study of Latissimus Dorsi and Teres Major Transfers

Reverse Shoulder Arthroplasty Combined with a Modified Latissimus Dorsi and Teres Major Tendon Transfer for Shoulder Pseudoparalysis Associated with Dropping Arm

“…The deltopectoral approach makes the identification, dissection, and transfer of the LD/ TM tendons relatively simple and safe, because the tendons are located at the medial border of the humerus immediately behind the pectoralis major tendon. A posterior incision is not needed, and through this approach, the transfer can be performed with no stretching or angulation of the neurovascular pedicle and the axillary and radial nerves can be identified and protected [3,34,39,43]. By both lowering and medializing the humerus, the reverse prosthesis facilitates the tendon reattachment at the epiphysis level.…”

“…Fascial adhesions were found inferiorly and released bluntly under direct visualization with the arm in adduction and flexion to relax the brachial plexus; dissection did not venture beyond 6 cm medial to the tendon insertions, as anatomic studies have identified the neurovascular pedicles to the latissimus dorsi and teres major at an average of 13.1 and 7.4 cm proximal to the humeral insertions, respectively [3,39]. When sufficient length was obtained (approximately 3-5 cm), the humerus was dislocated anteriorly and the tendons were transferred around its posterolateral aspect (Fig.…”

Reversed shoulder Arthroplasty with modified L'Episcopo for combined loss of active elevation and external rotation

“…To avoid damage to the neurovascular pedicles, dissection should not extend more than 6 cm medially, and the radial nerve, passing medially over the anterior surface of the LD, should be carefully identified and protected. 3,25 Adhesions are usually encountered inferiorly, and these should be divided under direct vision (Fig 3, C). Completion of the release increases the available excursion of the combined myotendinous unit by approximately 3 to 5 cm (Fig 3, D).…”

Management of massive and irreparable rotator cuff tears

“…81 In addition, the radial nerve is close to the donor tendon insertion site, and a rate of neurapraxia has high as 5% has been reported. 32,61 For anterosuperior rotator cuff tears, the pectoralis major has been the most commonly used donor tendon. It contains ample amount of tendon and generates sufficient force to be an appropriate candidate for transfer.…”