Latissimus Dorsi Tendon Transfer

The Goal

Dr. Kevin Wall provides specialized, fellowship-trained surgical treatment for Latissimus Dorsi Tendon Transfer to restore function and relieve pain for patients in Richmond, VA, and the surrounding Central Virginia communities. The goal of this complex reconstruction is to restore shoulder balance in patients with a massive, irreparable tear of the subscapularis tendon. The subscapularis is the primary muscle responsible for internal rotation and for keeping the humeral head centered in the front of the socket. When it is irreparably torn, the shoulder becomes unstable ("anterior escape"), leading to severe pain and weakness. By transferring the latissimus dorsi tendon to the native subscapularis insertion location, we create a new, functional checkrein that mimics the subscapularis, restoring the ability to rotate the arm inward and preventing the shoulder from slipping out the front. A thorough evaluation must be done preoperatively with MRI. Not every patient is a candidate for a tendon transfer, especially the elderly or those with osteoarthritis. A reverse shoulder arthroplasty may be better suited in these cases.

This page is designed to educate you specifically about this procedure. Additional information that generally applies to most of Dr. Wall’s surgeries can be found on these pages:

The Procedure

  • The Approach: This is a technically challening procedure often performed using an arthroscopic-assisted technique. One small incision is made in the armpit (axilla) to harvest the tendon, while the fixation is often managed arthroscopically to minimize soft tissue damage. Occasionally, a separate open incision is used over the front of the shoulder to manage transfer fixation.

  • Tendon Harvest: The latissimus dorsi tendon is identified and detached from its insertion on the humerus. High-strength sutures are woven into the tendon end to prepare it for transfer.

  • The Transfer: The tendon is passed through a carefully created tunnel between the muscle layers to reach the front of the shoulder joint.

  • Fixation: Dr. Wall secures the transferred tendon to the original subscapularis footprint (lesser tuberosity) using heavy-duty bone anchors This restores the anterior force couple necessary for shoulder function.

Post-Op Protocol

  • Immobilization (Phase 1: 0–8 weeks): Strict protection is required to allow the transferred tendon to heal in its new position. You must wear a sling at all times, except for hygiene and dressing. You may perform elbow, wrist, and hand motion, but no formal physical therapy for the shoulder is performed during this period. No weightbearing, pushing, or pulling is permitted.

  • Formal PT Start: Professional physical therapy begins at Post-Op Week 8.

  • Phase 2 (8–16 weeks): The sling is discontinued. Therapy focuses on progressive passive, active-assisted, and eventually active motion as tolerated. To protect the transfer, lifting, pushing, and pulling remain restricted.

  • Phase 3 (16–24 weeks): Progressive stretching continues. Strengthening exercises begin using resistance bands.

  • Phase 4 (24 weeks+): Ongoing stretching and strengthening, progressing to weights as tolerated.

When to Seek Care

You should schedule a consultation if:

  • You have been told you have a "massive" or "irreparable" subscapularis tear.

  • You cannot press your hand against your belly (positive Belly Press test) or lift your hand off your lower back (positive Lift-Off test).

  • You feel your shoulder slipping forward or have severe fatigue with simple activities like pushing a door open.

  • You cannot lift your arm forward in front of you, which can be a sign of anterior escape.