title: Outcome of transfer of the sternal head of the pectoralis major with its bone insertion to the scapula to manage scapular winging.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the outcome of transfer of the sternal head of the pectoralis major with its bone insertion to the inferior pole of the scapula for symptomatic winging.
  
  
  METHODS
  Our study included 51 patients with serratus anterior dysfunction secondary to chronic muscle or long thoracic nerve injury. Indications included pain, scapular winging, and limited active motion after failed conservative management. All patients underwent transfer of the sternal head of the pectoralis major with its bone insertion to the scapular inferior pole. Computed tomography scan was performed at 3 months postoperatively to evaluate bone healing.
  
  
  RESULTS
  At an average follow-up of 29 months (range, 12-46 months), 45 patients had complete and 6 patients had partial resolution of the scapular winging. Patients had significant improvements in their shoulder abduction, forward flexion, and pain levels (P < .01). The mean shoulder Constant score improved from 49 preoperatively to 82 postoperatively; the shoulder subjective value improved from 60% to 84%; and the Disabilities of the Arm, Shoulder, and Hand score improved from 58 to 14 (P < .01). Computed tomography scans at an average of 3 months postoperatively demonstrated full healing in 41 patients and partial healing in 10.
  
  
  CONCLUSIONS
  Pectoralis major transfer of the sternal head with its bone insertion to the inferior pole of the scapula is a reliable transfer to stabilize and to restore the function of the scapula in patients with symptomatic winging. This technique allows the ability to directly transfer the tendon to the scapula with bone-to-bone healing, leading to faster healing and a quicker return to unrestricted activities.
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: elhassan.bassem@mayo.edu.
authors.forename: Bassem T
authors.initials: BT
authors.lastname: Elhassan
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Wagner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000293:injuries / Q000503:physiopathology; D010369:Pectoralis Muscles / Q000601:surgery*; D059348:Peripheral Nerve Injuries / Q000150:complications; D011859:Radiography; D016059:Range of Motion, Articular; D012540:Scapula / Q000000981:diagnostic imaging / Q000601:surgery*; D012785:Shoulder Joint / Q000503:physiopathology* / Q000601:surgery; D020069:Shoulder Pain / Q000209:etiology / Q000601:surgery; D013249:Sternum / Q000601:surgery; D013709:Tendon Transfer / Q000379:methods*; D013900:Thoracic Nerves / Q000293:injuries; D014945:Wound Healing; D055815:Young Adult
keywords: Pectoralis major transfer; scapular winging