Surgical Release of the Pectoralis Minor Tendon for Scapular Dyskinesia and Shoulder Pain

Abstract

Pectoralis minor tightness has been linked to pain and dysfunction of the shoulder joint secondary to anterior tilt and internal rotation of the scapula causing pseudo-impingement of the subacromial space. The purpose of this study is to describe the outcomes pertaining to non-operative treatment and operative treatment via surgical release of the pectoralis minor tendon for pathologic pectoralis minor tightness in an active population. Over a 3-year period, a total of 46 patients were enrolled (mean age 25.5, range 18-33). Inclusion criteria: symptomatic shoulder pain, limited range of overhead motion, inability to perform overhead lifting activities, and scapular dysfunction secondary to a tight pectoralis minor with tenderness to palpation of the pectoralis minor tendon. All patients underwent a physical therapy and stretching program (mean 11.4 months, range 5-23), followed by serial examinations for resolution of symptoms and scapular tilt. 6/46 (13%) patients did not adequately recover and underwent isolated mini-open pectoralis minor release. Outcomes were assessed with scapula protraction measurements, pain scales, and ASES, SANE and VAS score. A total of 40/46 (87%) patients resolved the tight pectoralis minor and scapular mediated symptoms with non-operative treatment (ASES 58-91; SANE 50-90; VAS 4.9-0.8, p<0.01), but six patients were considered non-responders (mean ASES 48, SANE 40, VAS 5.9) and elected to have surgical pectoralis minor release, which improved scores in all domains (ASES 89; SANE 90.4; VAS 0.9, p<0.01). Additionally, protraction of the scapula improved from 1.2 to 0.3 cm in a mean midline measurement from the chest wall, preoperatively to postoperatively (p<0.01), similar to non-operative responders. All patients returned to full activities with no surgical complications. Although pectoralis minor tightness can be mostly treated non-operatively, this series demonstrates return to function with notable improvement in shoulder symptoms after surgical release of the pectoralis minor tendon.