Pectoralis muscle transfer for Subscapularis incompetence/irreparable tear

September 4th, 2007

When the Subscapularis muscle is incompetent either due to a failure of its tendinous insertion to heal after previous surgery or following post-traumatic injury, the shoulder may be unstable.

Episodes of slipping out the front (subluxation) or dislocation are best treated by re-repair of the subscapularis tendon, but if that tendon is not repairable then a tendon transfer may be required.

The pectoralis major muscle is an ideal donor--routed deep to the conjoint tendon and inserted onto the greater tuberosity with the shoulder reduced and in external rotation. Stability and functional use can be restored with little risk of complication, by as early as 2 months after surgery.

Related Photos:

Preoperative AP xray suggests subluxation

Preoperative axillary lateral shows anterior subluxation. 3 years earlier a capsular shift was performed

Intraoperative photo shows tagged capsule for revision capsular shift, but the subscapularis tendon was pathologically thinned and incompetent

Pectoralis major tendon has been passed deep to the conjoint tendon

Pectoralis major tendon has been sewn to the greater tuberosity to complete the tendon transfer. This will restore anterior stability that was compromised by the absence of a functioning subscapularis tendon

Forward flexion 2 months after surgery. She has experienced no episodes of instability

Postoperative external rotation has not been restricted

Lift off is strong, consistent with functioning tendon transfer to replace subscapularis function

Postoperative AP xray shows that the humeral head is now reduced anatomically within the glenoid socket

Related Videos:

Early postoperative outcome following Pectoralis major transfer to substitute for incompetent Subscapularis