Clinical outcomes following arthroscopic pectoralis minor release

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Neurosurgery

Background:

• Pectoralis minor syndrome (PMS) and neurogenic thoracic outlet syndrome (nTOS) are underrecognized causes of shoulder dysfunction.
• Etiologies include congenital or acquired shortening, fibrosis, or hyperactivity of the pectoralis minor (PMi) muscle.
• This study investigates arthroscopic PMi release for PMS and nTOS.

Purpose of the Study:

• To evaluate the safety and effectiveness of arthroscopic PMi release for PMS and nTOS.
• To determine the incidence of anomalous PMi insertional anatomy in patients with PMS and nTOS.

Main Methods:

• Retrospective chart review of 273 patients undergoing arthroscopic PMi release between 2021-2024.
• Collection of patient demographics and pre/post-operative patient-reported outcome measures (PROMs).
• Intra-operative arthroscopic evaluation of PMi anatomy and surrounding structures.

Main Results:

• Significant improvements in Subjective Shoulder Value (SSV), VAS pain, PROMIS physical function, and quickDASH scores post-surgery (p<0.05).
• Postoperative forward elevation significantly improved (p=0.002).
• Anomalous PMi insertion occurred in 15.4% of patients; 12 complications (4.4%) were reported.

Conclusions:

• Arthroscopic PMi release with brachial plexus neurolysis is effective for PMS and nTOS, improving PROMs with a low complication rate.
• The incidence of anomalous PMi anatomy is similar to the general population.
• Muscle hyperactivity is implicated as a cause of PMS.