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Split Pectoralis Tendon Transfer

What Is a Split Pectoralis Major Tendon Transfer?

A split pectoralis major tendon transfer is a surgical procedure performed to improve shoulder function when the serratus anterior, which holds the scapula (shoulder blade) flat against the ribcage, no longer functions. This is usually a result of long thoracic nerve injury.

The pectoralis major muscle (the chest muscle) has two parts:

  • Clavicular (upper) head
  • Sternal (lower) head

In this procedure, only part of the pectoralis tendon—the lower portion—is detached and moved to the inferior scapula to help replace the lost function of the serratus anterior muscle.

This transfer gives the shoulder a new active muscle to restore stability of the shoulder blade and especially forward flexion strength of the arm.

Who Is a Good Candidate?

You may be recommended for this surgery if:

  • You have long thoracic nerve palsy that hasnot improved after 9–18 months of non-surgical treatment.
  • You have persistent scapular winging despite extensive rehab.
  • Your shoulder joint is otherwise stable and healthy.
  • You are motivated to participate in post-surgical physical therapy.

This surgery is not the same as pectoralis transfer used for rotator cuff (subscapularis) tears—it is specifically for scapular winging from nerve palsy.

Benefits of Surgery

Patients often experience:

  • Reduced or eliminated scapular winging
  • Improved strength and function, especially in forward flexion
  • Higher tolerance for overhead activity
  • Better endurance during sports, work, and daily tasks

Risks and Possible Complications

All surgeries have some risks, including:

  • Infection
  • Failure of the tendon transfer to heal
  • Persistent weakness or winging

What to Expect After Surgery

Recovery requires patience and commitment to a structured rehabilitation program. The tendon needs time to heal in its new position and retrain the brain and shoulder muscles for new movement patterns.

Phase 1: Protection Phase (0–6 Weeks After Surgery)

  • The arm will be placed in a sling forabout 6 weeks.
  • You may start light hand, wrist, and elbow motion immediately.
  • No lifting, pushing, or pulling with the operated arm.

 

Phase 2: Early Motion (6–12 Weeks)

Goals:

  • Begin restoring shoulder movement
  • Continue protecting the surgical repair

What to Expect:

  • Brace is discontinued
  • Therapy progresses to:
    • Passive and active-assisted range of motion
    • Gentle stretching
    • Scapular (shoulder blade) exercises

Restrictions:

  • Still no strengthening of the shoulder
  • No lifting more than a small object (like a coffee cup)

Months 3–6

  • Strengthening becomes more progressive.
  • Patients usually start returning to:
    • Light work duties
    • Basic sports drills
  • Overhead motion becomes easier and more controlled.

Phase 3: Strengthening Phase (3–6 Months)

Goals:

  • Re-educate the transferred tendon to function like the serratus anterior muscle
  • Improve strength and control of shoulder blade and shoulder muscles
  • Build stable shoulder mechanics for daily activities

Therapy Focus:

  • Rotator cuff strengthening
  • Scapular stabilization
  • Functional patterns that teach the new tendon to work in its new role

Strength gains are gradual, and coordination training is especially important.

Phase 4: Functional Return (6–12 Months)

Goals:

  • Regain strength and endurance needed for work, hobbies, and sports

Most patients return to:

  • Regular daily activities by 3–6 months
  • Light sports between 6–9 months
  • Higher-demand activities (like gym and overhead sports) after 9–12 months

Expected Outcomes

Most patients experience:

  • Significant pain relief
  • Improved strength, especially in forward flexion
  • Better shoulder blade (scapula) control and function

However:

  • Full strength may not return
  • Patients may experience some persistent pain or scapular winging

Commitment Matters

This procedure requires a long rehabilitation period and high patient motivation.

 

 

I hope this provides some useful information regarding the procedure and recovery. Please never hesitate to schedule a consultation with Dr. Huff if you think you may benefit from this procedure.

Best,

Scott Huff, MD