Pectoralis Major Tendon Transfer for Subscapularis Insufficiency: A Biological Bail-Out

Injuries of the subscapularis can cause pain, instability, and loss of shoulder function. Atrophy and fatty degeneration may preclude direct repair, and transfer of the pectoralis major tendon has been described as a successful salvage procedure that relieves pain and restores stability and function. Techniques involving transfer of the tendon over or under coracobrachialis have been developed and refined with the aid of biomechanical studies. Outcomes have been good with all techniques despite low scores on objective outcome measures. A good knowledge of the relevant anatomy, biomechanical principles, and pitfalls of pectoralis major transfer will allow for successful patient outcomes.