A comprehensive analysis of pectoralis major transfer for long thoracic nerve palsy

Chalmers, Peter N.; Saltzman, Bryan M.; Feldheim, Terrence F.; Mascarenhas, Randhir; Mellano, C; Cole, Brian J.; Romeo, Anthony A.; Nicholson, Gregory P.

doi:10.1016/j.jse.2014.12.014

Cited by 18 publications

(16 citation statements)

References 24 publications

(60 reference statements)

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“… 3 , 20 , 21 , 23 Chalmers et al. 29 retrospectively compared outcomes between patients treated with the indirect (n = 14) and direct (n = 10) transfer techniques. At a mean follow-up of 4.3 years, there were no significant differences in risk of recurrence, range of motion, or American Shoulder and Elbow Surgeons scores.…”

Section: Discussionmentioning

confidence: 99%

Split Pectoralis Major Transfer for Chronic Medial Scapular Winging

Choate

Kwapisz

Tokish

2017

Arthroscopy Techniques

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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.

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Section: Discussionmentioning

confidence: 99%

Split Pectoralis Major Transfer for Chronic Medial Scapular Winging

Choate

Kwapisz

Tokish

2017

Arthroscopy Techniques

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“…In addition, a physical examination that assesses for periscapular pain with particular attention paid to tenderness to palpation of the coracoid, while any decrease in shoulder range of motion and strength is also noted, is needed for an accurate diagnosis. 18 , 19 As part of the physical examination, evaluation of the positioning of each scapula with respect to the other scapula as the shoulder goes through its range of motion is particularly important, with attention paid to the inferior-medial border of the symptomatic scapula. If any sign of asymmetry is recognized, this will reveal the cause of the patient's complaints.…”

Section: Discussionmentioning

confidence: 99%

“…In a systematic review performed by Chalmers et al. 19 comparing direct versus indirect pectoralis major transfer for serratus anterior palsy, patients who underwent an indirect transfer (i.e., performed with augmentation through use of an autograft) were significantly more likely to have recurrent medial instability develop and show lower postoperative forward flexion than those who underwent a direct transfer. In all, we believe direct transfer of the pectoralis major to the inferior border of the scapula, as described, provides an effective and safe method to treat scapular winging resulting from serratus anterior dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Pectoralis Major Transfer for Treatment of Serratus Anterior Dysfunction in the Setting of Long Thoracic Nerve Palsy

Sánchez

Ferrari

Sanchez

et al. 2017

Arthroscopy Techniques

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Symptomatic scapular winging resulting in scapular dyskinesia leads to a wide spectrum of clinical complaints, most notably periscapular pain. The malpositioning of the scapula, termed through use of the acronym SICK (scapular malposition, inferior-medial border prominence, coracoid pain and malposition, and dyskinesia of scapular movement), is due to the irregular activity of one or more of the periscapular muscles. In particular, the serratus anterior, innervated by the long thoracic nerve, is a key muscle that stabilizes the scapula and provides coordinated scapulohumeral rhythm. If the long thoracic nerve is injured, this results in significant shoulder dysfunction and scapular winging that may require surgical intervention. The purpose of this Technical Note is to present our preferred technique to treat symptomatic scapular winging due to long thoracic nerve palsy through transfer of the pectoralis major with its bone insertion to the inferior edge of the scapula.

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“…Overuse long thoracic nerve injuries in throwing athletes typically spontaneously resolve with nonsurgical management in 6–18 months 71 . A shorter recovery time course of 6 to 9 months has been reported in athletes 157,158 . Nonoperative management will consist of rest from throwing and physical therapy.…”

Section: Peripheral Neuropathies In Throwing Athletesmentioning

confidence: 99%

A review of upper extremity peripheral nerve injuries in throwing athletes

Bowers

Cherian

Zaremski

2022

PM&R

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Peripheral nerve injuries in the upper extremities may be common in throwing athletes as the throwing motion places extreme stress on the dominant arm. The combination of extreme stress along with repetitive microtrauma from throwing uniquely places the throwing athlete at elevated risk of upper extremity peripheral nerve injury. However, because symptoms can be nonspecific and frequently coexist with pathology in the upper extremity, the diagnosis of peripheral nerve injury is often delayed. Diagnosis of peripheral nerve injuries may require a combination of history and physical examination, diagnostic imaging, electrodiagnostic testing, and diagnostic ultrasound-guided injections. The primary management should include physical therapy focusing on throwing mechanics and kinetic chain evaluation. However, some athletes require surgical intervention if symptoms do not improve with conservative management. The purpose of this focused narrative review is to highlight upper extremity peripheral neuropathies reported in throwing athletes and to provide an overview of the appropriate clinical diagnosis and management of the throwing athlete with a peripheral nerve injury.

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A comprehensive analysis of pectoralis major transfer for long thoracic nerve palsy

Cited by 18 publications

References 24 publications

Split Pectoralis Major Transfer for Chronic Medial Scapular Winging

Split Pectoralis Major Transfer for Chronic Medial Scapular Winging

Pectoralis Major Transfer for Treatment of Serratus Anterior Dysfunction in the Setting of Long Thoracic Nerve Palsy

A review of upper extremity peripheral nerve injuries in throwing athletes

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