Surgical Technique and Anatomic Study of Latissimus Dorsi and Teres Major Transfers

by Andrew D. Pearle, Bryan T. Kelly, James E. Voos, Eric L. Chehab, and Russell F. Warren

J Bone Joint Surg AmVolume 88(7):1524-1531

July 1, 2006

©2006 by The Journal of Bone and Joint Surgery, Inc.

Figs. 1-A, 1-B, and 1-C Relationship of the radial nerve to the latissimus dorsi and teres major tendons.

Andrew D. Pearle et al. J Bone Joint Surg Am 2006;88:1524-1531

©2006 by The Journal of Bone and Joint Surgery, Inc.

The latissimus dorsi and the teres major have been lifted up to reveal the radial nerve in its fatty tissue.

Andrew D. Pearle et al. J Bone Joint Surg Am 2006;88:1524-1531

©2006 by The Journal of Bone and Joint Surgery, Inc.

Anterior view of the latissimus dorsi insertion site on the humerus, with the pectoralis major, deltoid, biceps, and brachioradialis removed.

Andrew D. Pearle et al. J Bone Joint Surg Am 2006;88:1524-1531

©2006 by The Journal of Bone and Joint Surgery, Inc.

Figs. 2-A and 2-B The effect of rotation on visualization of the tendinous insertions of the teres major and latissimus dorsi from the posterior view.

Andrew D. Pearle et al. J Bone Joint Surg Am 2006;88:1524-1531

©2006 by The Journal of Bone and Joint Surgery, Inc.

Maximum internal rotation delivers the tendons into the surgical field and allows for safe tenotomy if care is taken to release the tendons directly off their insertion sites on the humerus.

Andrew D. Pearle et al. J Bone Joint Surg Am 2006;88:1524-1531

©2006 by The Journal of Bone and Joint Surgery, Inc.

Diagram of the length measurements from the tendon insertion sites on the humerus to the neurovascular pedicles; the anterior aspect of the shoulder is depicted.

Andrew D. Pearle et al. J Bone Joint Surg Am 2006;88:1524-1531

©2006 by The Journal of Bone and Joint Surgery, Inc.

A hemithorax specimen, in the lateral decubitus position, demonstrating requisite mobilization of the teres major and latissimus dorsi off the chest wall.

Andrew D. Pearle et al. J Bone Joint Surg Am 2006;88:1524-1531

©2006 by The Journal of Bone and Joint Surgery, Inc.

The course of the posterior branch of the axillary nerve as it runs in the deep deltoid fascia is demarcated with white pins.

Andrew D. Pearle et al. J Bone Joint Surg Am 2006;88:1524-1531

©2006 by The Journal of Bone and Joint Surgery, Inc.

The posterior deltoid has been reflected laterally to demonstrate the proximity of the tendon transfer to the course of the posterior branch of the axillary nerve.

Andrew D. Pearle et al. J Bone Joint Surg Am 2006;88:1524-1531

©2006 by The Journal of Bone and Joint Surgery, Inc.