Summary

In refractory and pathologically tight pectoralis minor tendon cases, surgical release of the pectoralis minor tendon demonstrates predictable return to function with notable improvement in shoulder symptoms.

Abstract

Background/Purpose: 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 secondary 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.

Methods

Over a 3-year period, a total of 46 patients were enrolled (mean age 25.5, range 18-33). Inclusion criteria consisted of: symptomatic shoulder pain, limited range of overhead motion, inability to participate in overhead lifting activities, and examination findings consistent with scapular dysfunction secondary to a tight pectoralis minor with tenderness to palpation of the pectoralis minor tendon. All patients underwent an extended period of physical therapy and stretching program (mean 11.4 months, range 3-23), then followed with serial examinations for resolution of symptoms and scapular tilt. A total of 6/46 (13%) patients were unable to adequately stretch the pectoralis minor and underwent isolated mini-open pectoralis minor release. Outcomes were assessed with scapula protraction measurements, pain scales, and ASES, SANE and VAS score.

Results

A total of 40/46 (87%) patients resolved the tight pectoralis minor and scapular mediated symptoms with a dedicated therapy program (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, with 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. There were no surgical complications and all patients returned to full activities.

Conclusions

In most patients, PM tightness can be successfully treated with a non-operative focused PM stretching program. However, in refractory and pathologically tight PM cases, this series demonstrates predictable return to function with notable improvement in shoulder symptoms after surgical release of the PM. Additional work is necessary to evaluate the long-term efficacy of isolated PM treatment.