When it comes to the case of irreparable subscapularis tendon ruptures, surgeons often vouch for the pectoralis major tendon transfer procedure. When such irreparable tears occur in young patients that have high functional demands, the surgical management of the condition through tendon transfer happens to be the most viable option. There have been cases that has seen at least 70% improvement following pectoralis major transfer.

 

The pectoralis major having the second longest excursion of 18.8 cm is possibly the top reason for its preference over other transfer which is that of the latissimus dorsi. The pectoralis major transfer is usually done on patients with more severe weakness that are caused by anterosuperior Rotator Cuff Tears. A significant reduction in pain and improvement in function and patient satisfaction has been seen after a pectoralis major transfer. When compared to the latissimi dorsi tendon transfer, the transfer of the pectoralis major has a much longer track record.

The advantage of the pectoralis major muscle and tendon is that they lie just below and in front of the subscapularis muscle, but too low to act as an internal rotator or flexor of the shoulder. The pectoralis major also has a very broad tendon and this makes it possible for a part of it to be transferred without affecting loss of strength to a great extent.

For the procedure that is performed under general anesthesia with an interscalene block, an incision is made at the front of the shoulder. The surgeon will then proceed to examine the torn tendons to assess for any chance of repair. Most of the time there is a likelihood of at least one half to two thirds of the pectoralis major tendon being detached and mobilized.

This tendon is then moved as high up the humerus as possible to exert a downward and internal rotation force on the shoulder, compensating for the subscapularis and supraspinatus muscles. The entire pectoralis tendon under the conjoined tendon will be transferred in order to avoid any injury to the musculocutaneous nerve which could be at risk otherwise.

The addition of the teres major component to the transfer has also been found to be beneficial in cases where both the upper and lower portion of the subscapularis muscle is irreparable. The surgeon’s skill level, training and experience is key here as it is extremely crucial for the surgeon to get the tension of the repair right. After this the transferred tendon is fixed to the bone with multiple strong suture-anchors. 

The optimal recovery following a pectoralis major tendon transfer can take over one year to achieve and this is dependent on a number of factors. Postoperative care after the procedure should continue for 4 to 6 weeks with immobilization in a rigid orthosis for the best outcome. Gentle passive motion can begin by 4 to 6 weeks postoperatively. Whereas active motion is usually postponed until 6 weeks. The patient may need to continue with therapeutic improvement or rehabilitation for up to one year after the tendon transfer.

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