Pectoralis minor tenotomy in the treatment of painful shoulder syndromes associated with scapular dyskinesis.

BACKGROUND

Scapular dyskinesis is an alteration in scapular position and movement that disrupts glenohumeral kinematics. Among its causes, pectoralis minor retraction induces scapular protraction and internal rotation, altering shoulder biomechanics. Often asymptomatic, scapular dyskinesis may also cause pain and reduced joint mobility, compromising function. Initial management relies on targeted rehabilitation, which generally ensures recovery. However, when conservative treatment fails, surgery may be considered. This study evaluates the clinical outcomes of arthroscopic pectoralis minor tenotomy in patients with painful shoulder and scapular dyskinesis due to pectoralis minor retraction.

METHODS

A retrospective monocentric study included patients operated on between 2020 and 2024 for painful shoulder syndrome associated with scapular dyskinesis secondary to excessive pectoralis minor tension. Patients undergoing concomitant or subsequent surgery on the same shoulder were excluded. We conducted a longitudinal intrasubject study comparing preoperative and postoperative outcomes. Patients were assessed preoperatively and at their last follow-up for active range of motion, pain (visual analog scale), Constant score, and simple shoulder value. Complications were recorded.

RESULTS

Thirty-seven patients met the entry criteria and were enrolled in the study with a mean follow-up of 19.9 months (range, 6 to 44). All patients were women (mean age 43.8), with 49% reporting trauma and 57% practicing sports. Among the 37 patients, information on preoperative corticosteroid injections was missing for 2 patients. Of the remaining 35, 34 (97%) received at least 1 injection. Functional scores and pain improved significantly postoperatively. The Constant score increased from 55.3 to 73.27 (P < .001), the visual analog scale decreased from 7.51 to 2.62 (P < .001), and the simple shoulder value rose from 46.75 to 74.73 (P < .001). Active elevation improved significantly from 128.38° to 143.9° (P = .013), while external and internal rotations showed no significant difference. Four cases of adhesive capsulitis were reported; three resolved with rehabilitation, while 1 patient retained stiffness in elevation at last follow-up.

CONCLUSION

When conservative treatment fails, arthroscopic tenotomy is an effective surgical option for patients with painful shoulder and scapular dyskinesis due to pectoralis minor contracture. This study demonstrates significant improvement in functional scores, pain, and anterior elevation range, while external and internal rotations remain unchanged. However, randomized studies with longer follow-up are needed to confirm result durability.