A comprehensive analysis of pectoralis major transfer for long thoracic nerve palsy

Background In the treatment of long thoracic nerve palsy with pectoralis major transfer, it remains unknown whether direct transfer of the pectoralis to the scapula or indirect transfer with an interpositional graft provides superior outcomes. Methods A 3-tiered study was performed to gain a compreh...

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Bibliographic Details
Published in:Journal of shoulder and elbow surgery 2015-07, Vol.24 (7), p.1028-1035
Main Authors: Chalmers, Peter N., MD, Saltzman, Bryan M., MD, Feldheim, Terrence F., BA, Mascarenhas, Randy, MD, Mellano, Chris, MD, Cole, Brian J., MD, Romeo, Anthony A., MD, Nicholson, Gregory P., MD
Format: Article
Language:English
Subjects:
Adult
allograft
Cohort Studies
Female
Humans
levels of evidence
Long thoracic nerve palsy
Male
meta-analysis
Mononeuropathies - surgery
Orthopedics
Paralysis - surgery
pectoralis major transfer
Pectoralis Muscles - innervation
Pectoralis Muscles - surgery
Practice Patterns, Physicians' - statistics & numerical data
Retrospective Studies
serratus anterior palsy
Surveys and Questionnaires
Tendon Transfer - methods
Thoracic Nerves - injuries
Thoracic Nerves - surgery
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Summary:Background In the treatment of long thoracic nerve palsy with pectoralis major transfer, it remains unknown whether direct transfer of the pectoralis to the scapula or indirect transfer with an interpositional graft provides superior outcomes. Methods A 3-tiered study was performed to gain a comprehensive understanding. (1) A survey of the membership of the American Shoulder and Elbow Surgeons (ASES) was conducted to reach a Level V consensus. (2) A systematic review was conducted to identify all series evaluating direct and indirect transfer of the pectoralis major tendon to create a Level IV consensus. (3) A retrospective review was performed to provide Level III evidence. Results (1) Surgeons were evenly split between whole and split tendon transfers, direct and indirect transfers, and graft types. More experienced surgeons were more likely to prefer an indirect transfer. (2) Analysis of 10 Level IV studies (131 shoulders) revealed that patients who underwent indirect transfer were significantly more likely to develop recurrent winging ( P  = .009) and had lower active forward elevation ( P  
ISSN:1058-2746
1532-6500
DOI:10.1016/j.jse.2014.12.014