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

Medial scapular winging is often due to dysfunction of the serratus anterior muscle as a result of injury to the long thoracic nerve. Impairment of the serratus anterior muscle may cause uncoordinated scapulohumeral rhythm during shoulder elevation and subsequent subscapular or shoulder pain, subacromial impingement, and glenohumeral joint instability. Although long thoracic nerve injury typically resolves in 12 to 18 months after a physical therapy regimen, surgical intervention is indicated in patients who fail conservative management. Both direct and indirect pectoralis major tendon transfer techniques have been described in the literature as surgical options for these patients. Indirect transfer of the pectoralis major and augmentation with either allograft or autograft has been shown to successfully restore scapular functioning and glenohumeral stability. We describe a technique that uses hamstring autograft to augment a pectoralis major transfer with the sternal head to correct medial scapular winging due to dysfunction of the long thoracic nerve and serratus anterior muscle atrophy.