Pectoralis major tears are a rare injury that can lead to significant strength deficits and unacceptable cosmesis. Recent literature on surgical outcomes has consistently shown excellent patient satisfaction and return to function. Delayed repairs, however, can be complicated by tendon retraction and adhesion, which make operative repair difficult and less effective than immediate repair, as reported in some studies. We have found the use of intraoperative transcutaneous electrical nerve stimulation as a safe and quick technical adjunct to define the soft tissue anatomy. By stimulating the muscle, it is possible to assess the degree of tendon adhesion and retraction, which can provide information to safely guide dissection. This technique can also be used for shoulder revision procedures when multiple deltopectoral approaches have scarred and obscured the native anatomical interval.
From the Integrated Department of Orthopaedics and Rehabilitation, National Naval Medical Center, Bethesda, MD and Walter Reed Army Medical Center, Washington, DC.
The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.
The views expressed in this paper are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government.
Reprints: David E. Gwinn, MD, Orthopedic Surgery Service, National Naval Medical Center, 8901 Wisconsin Ave, Bethesda, MD (e-mail: email@example.com).