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Pectoralis Major Tendon Transfer for Management of Medial Scapular Winging
Scapular winging is an uncommon condition that results in abnormal motion of the scapula, causing pain and decreased function of the upper extremity. The diagnosis can be made with a thorough physical examination and proper diagnostic studies. The most common type of scapular winging is medial winging resulting from a palsy of the long thoracic nerve that leads to dysfunction of the serratus anterior muscle. This dysfunction causes the scapula to displace from the ribs when forward flexion is attempted. If nonsurgical management is unsuccessful, surgical management should be considered. Surgical management of medial winging of the scapula can consist of transfer of the entire pectoralis major tendon, which is referred to as the direct procedure, or transfer of the sternal portion only, which is referred to as the indirect procedure. Allograft or autograft tissue can be used to augment the tendon transfer.