If the patient has failed to improve with therapy and has elected to move forward with surgery, the recommended surgery is a split-pectoralis tendon transfer. This surgery is performed by making a small incision near the patient’s armpit, on the arm. Through this incision, the pectoralis tendon is identified. Either a portion of the tendon, or the entire tendon is then taken off the bone. Sutures are placed in the end of the tendon to help guide the tendon while being moved. A second incision is then made near the bottom of the scapula. The tendon and sutures are passed under the arm, and back to the second incision. Here, with the aid of some donor tissue, the tendon is then inserted onto the scapula. The purpose of the tendon transfer is that when contracted, the scapula will remain flat against the back as the arm is moved.
This surgery is done on an outpatient basis, meaning you would come in and go home on the same day of surgery. After surgery, you are placed in a sling for six weeks to allow the tendon to heal in its new location. After six weeks, the sling would be discontinued and physical therapy would begin. Full recovery is typically six months after surgery.