Acute Repair of Latissimus Dorsi and Teres Major Tendon Tears

Latissimus dorsi and teres major tendon tears are rare, typically occurring in high-level throwers but also from sudden shoulder extension or hyperabduction. While nonoperative management was previously preferred, recent literature favors operative repair, especially for complete, retracted tears.

Recent literature suggests partial-thickness tears can be managed nonoperatively, allowing return to competitive play, while repair is recommended for higher-grade tears to restore full performance. This approach can also apply to young, active individuals seeking full shoulder function.

Patient positioning is lateral decubitus with a bean bag, and an arm positioner aids exposure of the latissimus through arm abduction/internal rotation. A curvilinear incision is made over the tendon defect, avoiding the posterior armpit, angled toward the posteromedial humerus. Skin flaps are raised for muscle visualization, and the latissimus dorsi and teres major are mobilized, protecting the radial nerve/deep brachial artery and axillary nerve/posterior circumflex vessels, respectively. The humerus is palpated, and the bony footprint is exposed with blunt Hohmann retractors. Two to 3 unicortical buttons are placed 1 to 1.5 cm apart. No. 5 FiberWire and FiberTape are passed to facilitate a tension-slide technique. Sequential reduction is performed starting distally, reducing the tendon and tying each button. The wound is irrigated and closed in layers, and a waterproof dressing with a shoulder immobilizer is applied. Rehabilitation begins with 6 weeks of strict immobilization in a shoulder immobilizer, with pendulums and passive range of motion (ROM) exercises starting at 2 weeks. From 6 to 12 weeks, the sling is discontinued, and passive/active ROM exercises, light isometrics, and stretching are introduced. After 12 weeks, light overhead activities or throwing may begin, with full return to sport delayed until at least 6 months.

Recent studies show high return-to-sport rates (75%) for both nonoperative and operative treatments, with faster recovery nonoperatively. However, athletes treated surgically had no significant decline in performance, which was observed in those treated nonoperatively, suggesting limited healing of complete tears and compensation ability.

Repair of latissimus/teres major tears is a safe, dependable option to restore function and preoperative athletic activity, as well as minimize pain in professional or recreational athletes.

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