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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Q&As on Pectoralis Major Transfer

1. What is pectoralis major transfer?

Pectoralis major transfer is the surgical relocation of a part of the pectoralis major muscle, mostly the sternal head, to address shoulder dysfunction or instability. This surgical process is primarily done for cases like  irreversible rotator cuff tears or shoulder instability caused by loss of bone. At the time of surgery, your surgeon will detach a part of the pectoralis major muscle from the area where it inserts into humerus and then reattach it to that part of the shoulder that is affected. This transfer surgery assists in compensating the damaged structures and enhances the stability and function of your shoulder. Generally, pectoralis major transfer is considered when conventional treatment fails to offer relief and restoration.

2. What are the different conditions that are treated by pectoralis major transfer?

Pectoralis major transfer is used for addressing numerous shoulder conditions, such as:

Irreversible rotator cuff tears

When conventional methods cannot treat severe rotator cuff damage, then pectoralis major transfer can help stabilize the shoulder conditions and restore its function.

Recurring shoulder dislocations

Those who are suffering from frequent shoulder dislocation issues can benefit from pectoralis major transfer to improve stability and prohibit further issues.

Shoulder instabilities

In cases where bone loss causes shoulder instability, transferring a part of the pectoralis major muscle helps in supporting the joint and enhancing function.

Thus, pectoralis major transfer is considered when all traditional treatments prove insufficient or ineffective in restoring the shoulder’s condition and stability.

3. Who is the right candidate for a pectoralis major transfer?

The right candidates for pectoralis major transfer include individuals with:

Severe shoulder dysfunction

Those who are having severe shoulder instability, recurring dislocations, or decreased functioning because of irreversible rotator cuff tears.

Failed traditional treatments

Patients who did not respond to non-surgical treatments such as physical therapies, medications, and injections

Loss of bone

Individuals having structural issues such as bone loss or weakness in muscles that results in shoulder instability are good candidates for pectoralis major transfer

Good health

Those who need pectoralis major surgery must be in good health and be able to withstand the rehabilitation process.

A proper evaluation by an orthopedic doctor assists in determining if pectoralis major surgery is suitable for an individual.

4. What is pectoralis major transfer’s long-term outlook?

The long-term outcome of pectoralis major transfer surgery  depends largely on factors such as the overall health of the individual, severity of the shoulder condition, and adherence to rehabilitation. However, many patients receive good improvements in their shoulder instability, functions, and overall quality of life after the procedure. With good post-operative care and physical therapies, individuals can regain their strength, mobility, and overall function with time. While outcomes are perfect for some patients, it is necessary to discuss all expectations and risks with your healthcare provider to make sure goals are achieved and there is an ideal recovery after the procedure.

5. Are there any alternatives to pectoralis major transfer?

There are several alternatives to pectoralis major transfer, but it depends on specific conditions and circumstances. Some of the alternatives include:

Transfer of tendons

In rotator cuff tears that are irreversible, tendon transfers that involve other muscles can be taken into consideration for restoring function and shoulder stability.

Shoulder arthroscopy

With minimum invasion arthroscopic process, shoulder injuries such as partial rotator cuff tears and labral tears can be repaired.

Joint replacement surgery

For some of the major cases of shoulder arthritis or irreversible damage, shoulder replacement surgery is an option for alleviating pain and enhancing functions.

Physical therapies and rehabilitation

Exclusive physical therapy programmes can assist in strengthening shoulder muscles, and enhancing a range of motion and are effective for some shoulder conditions.

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