Pectoralis Major Tendon Transfer for the Treatment of Long Thoracic Nerve Palsy: Outcomes and Comparison of Direct vs. Indirect Transfer Techniques
Authors: Reuben Gobezie, Christopher McCrum, Yousef Shishani, J P Wanner, R J Nowinski, Jon J.P. Warner
References: Presented at ICSES 2010
Aims: Pectoralis major tendon (PMT) transfer has been described as a treatment for long thoracic nerve (LTN) palsy. Direct transfer is a transfer of the pectoralis major tendon to the lateral border of the scapula without interposed allograft. Indirect transfer involves passage of the pectoralis major tendon to the inferior medial border of the scapula with interposed allograft. The purpose of this study is to evaluate the clinical outcomes of PMT transfer for the treatment of LTN palsy and determine if either the direct or indirect PMT transfer gives superior results.
Methods: 25 patients who underwent PMT transfer for LTN palsy were reviewed retrospectively from three surgeons. Both direct PMT transfer (n=3) and indirect (n=22) were used. The average age was 37.8 years and mean follow-up was 24.7 months. Outcome measures used for this study included a visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, range of motion, and complications.
Results: PMT transfer resulted in significant improvement in almost all outcome measures evaluated. The mean ASES score improved from 28.3 pts (S.D.13.1, range 10-54) to 58.6 pts (S.D.24.7 pts, range 20-98)(p=0.00001). The pain improved from 8.0 (1.4, range 6-10) to 2.9 (S.D.2.6, range 0-9) (p<0.000001). Active forward flexion preoperatively was 107.1 (S.D.40.2, range 30-170) and postoperatively improved to 146.5 (S.D.26.8, range 90-180)(p<0.001). There was no statistically significant difference between indirect and direct PTM transfer. Three patients (13%) continued to have winging of the scapula although it was mild in all cases.
Conclusions: PTM transfer for the treatment of LTN palsy is a successful procedure resulting in significant improvement in overall pain and function. The complication rate for this procedure is relatively low. There was no statistically significant difference in outcomes between direct and indirect PTM transfer.