Presentation
Right shoulder pain.
Patient Data
Small circular defect in the inferomedial aspect of the right scapula, consistent with a burr hole.
Best seen on the axial T1 and sagittal PD images, the pectoralis major tendon (sternal head) courses posteriorly through the axillary region where there is anastomosis to a hamstring tendon allograft which leads into the inferomedial aspect of the scapula. The in-phase axial image shows foci of susceptibility artefact predominantly along the course of the re-routed pectoralis major tendon with a relative lack of susceptibility artefact in the segment between the axilla and scapula in the area of the hamstring tendon allograft. The tendon transfer appears intact. There is no atrophy of the pectoralis major muscle.
Sagittal PD and T2 fat sat images show atrophy and edema-like signal of the serratus anterior muscle, which likely represents sequelae of long thoracic nerve injury/entrapment.
Case Discussion
The radiographs and MRI show findings consistent with a pectoralis major tendon to scapula transfer. This procedure is used as a treatment for scapular winging. The pectoralis major tendon and allograft are intact. Note that the allograft is smaller in caliber than the pectoralis major tendon.