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Pectoralis Major to Scapula Transfer for Patients With Serratus Anterior Palsy

Borges, Cristian Stein MD; Ruschel, Paulo Henrique MD; Ferreira, Marco Tonding MD

Techniques in Hand & Upper Extremity Surgery: September 2011 - Volume 15 - Issue 3 - p 135–137
doi: 10.1097/BTH.0b013e3181fb5478

Serratus anterior palsy can be a very disabling condition. However, not much has been written about many other upper limb palsies and the surgical approaches for them. In contrast, not much has been published about this particular muscle palsy. Most investigators engaged in the treatment of peripheral nerve palsies are focused on the restoration of elbow flexion/extension and shoulder abduction/external rotation. Nevertheless, scapulothoracic stability is of utmost importance for shoulder function inasmuch as it offers a stable base for arm motion—mostly forward flexion. As a result, serratus anterior palsy leads to loss of strength, range of motion, and pain due to fatigue of synergistic muscles—an issue disabling enough to warrant surgical intervention. Many investigators have suggested a variety of techniques including muscle transfers, fascial slings, or scapulothoracic fusion. The last option leads to obvious limitations in the final range of motion and should be avoided in young high-demand patients. Fascial slings have a tendency to attenuate over time.

Complexo Hospitalar Santa Casa, Porto Alegre, Rio Grande do Sul, Brazil Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding

Address correspondence and reprint requests to Cristian Stein Borges, MD, Complexo Hospitalar Santa Casa, 825/305 Leopoldo Bier St, Porto Alegre, RS, Brazil 90620-100. e-mail:,

© 2011 Lippincott Williams & Wilkins, Inc.