Muscle transfers involving the shoulder.

Muscle transfer provides a viable treatment option for several difficult problems involving the shoulder. Muscle transfer is often the only alternative to a salvage procedure such as shoulder fusion, and whereas salvage procedures provide pain relief at the cost of function, muscle transfer can provide pain relief while retaining acceptable function. The five most commonly encountered shoulder problems for which muscle transfer can be utilized are subscapularis rupture, irreparable rotator cuff tear, deltoid injury and dysfunction, trapezial paralysis, and serratus anterior scapular winging. Although numerous muscle transfer procedures have been described, the following procedures have proven the most reliable and are the focus of this article: 1) transfer of the pectoralis major for subscapularis rupture, 2) transfer of the latissimus dorsi for irreparable rotator cuff tears, 3) latissimus dorsi transfer for deltoid injury or dysfunction, 4) modified Eden-Lange procedure for trapezial paralysis, and 5) modified Marmor-Bechtol pectoralis major transfer for serratus anterior scapular winging.