Direct pectoralis major muscle transfer for dynamic stabilization of scapular winging

Twelve consecutive patients with long thoracic nerve palsy, who underwent transfer of the pectoralis major muscle for dynamic stabilization of the scapula, were reviewed. Direct transfer of the tendon to the lateral margin of the inferior scapular angle was performed with a bony chip from the tendon's insertion. All patients were followed up clinically by evaluation of the Constant score and radiographically with magnetic resonance imaging for an average of 92.5 months (range, 60-136 months). The mean Constant score improved from 41 to 85.4 points. Mean active flexion increased from 89° to 171°, mean abduction from 86° to 161°, and mean external rotation from 48° to 63°. The final outcome was rated as excellent in 10 patients and good in 2. The magnetic resonance imaging findings showed no structural alterations, such as fatty degeneration or muscle atrophy of the transferred muscle, but showed traumatic incomplete rupture of the transferred tendon in 1 patient.