Combined serratus anterior plication and pectoralis minor release improves clinical outcomes in refractory scapular dyskinesis with neurological involvement

Scapulopexy can effectively treat symptomatic scapulothoracic dyskinesis. In patients with preserved serratus anterior function, restoring scapular positioning without rib-based fixation may reduce surgical risks and rib osteolysis. This study introduces a modified technique-Serratus Anterior Plication and PEctoralis minor Release (SAPPER)-and reports its outcomes in patients with refractory scapular dyskinesis associated with neurologic symptoms. Patients referred for treatment of symptomatic scapular dyskinesis were included if electromyography revealed lower brachial plexus dysfunction without peripheral nerve injury and shoulder magnetic resonance imaging excluded rotator cuff tears or instability. Patients were clinically evaluated at a minimum of 6 months postoperatively by 2 independent investigators. Postoperative to preoperative differences were evaluated, and subgroup analysis was performed to identify the effect of preoperative medical treatment. Forty patients were included, with preoperative symptoms lasting a median of 4 (3-6) years. Intraoperatively, the following lesions were identified: superior labrum anterior to posterior lesions (77.5%), rotator interval lesions (27.5%), and medial pulley lesions (70%). Constant Score, Subjective Shoulder Value, Numeric Rating Scale, and shoulder flexion significantly improved from baseline to final follow-up (P < .0001). All patients reported recovery of neurologic symptoms. Preoperative use of nerve pain medications or corticosteroids did not significantly influence outcomes. The SAPPER technique is a safe and effective modification of traditional scapulopexy. It enhances scapular positioning and serratus function without the need for rib-based fixation, potentially minimizing complications. This approach significantly improves pain, function, and mobility in patients with refractory scapular dyskinesis and associated neurogenic thoracic outlet syndrome.