Split Pectoralis Major Tendon Transfer With Achilles Allograft for Chronic Medial Scapular Winging

Split pectoralis major tendon (PMT) transfer is effective at treating persistent medial scapular winging refractory to conservative management.

The primary indication for a PMT transfer is scapular winging secondary to serratus anterior palsy caused by long thoracic nerve injury. In this case, the patient is a 22-year-old male with years of symptoms that interfere with his activities of daily living and ability to play recreational basketball.

The patient was placed in a semi-supine position. The deltopectoral interval was identified and dissected. The sternal head of the pectoralis major was isolated and tagged, and a tenotomy was then performed. An Achilles allograft was prepared in a sterile fashion and secured to the pectoralis tendon using multiple heavy nonabsorbable sutures. A scapular incision was made to identify the inferior angle of the scapula. A bone tunnel was created, and the allograft was shuttled through the aperture and tensioned into place.

Split PMT transfer is associated with improved pain scores and functional outcomes, while offering a lower complication rate than other surgical techniques. Patient satisfaction is high; 80% of patients would recommend the surgery. The patient in this case is now 16 weeks post-surgery and reports 0 out of 10 pain.

This technique study demonstrates that split PMT transfer with Achilles allograft augmentation is a viable treatment option for patients with persistent scapular winging.

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.