11/06/2026
📚 👨🎓 Neuromotor disorders of the shoulder remain difficult to understand, diagnose, and treat. One of the main reasons is that they are often poorly captured by conventional imaging or complementary investigations. MRI, CT scan, or ultrasound may fail to explain the patient’s symptoms, because the problem is not always structural. It may be dynamic, functional, and related to altered motor control.
I was first encouraged to explore this pathway by Elhassan, whose work on scapulothoracic mechanics and extra-articular causes of shoulder dysfunction has been highly influential. Scapular dyskinesis is not a diagnosis in itself, but an alteration of scapular position and motion that may disrupt glenohumeral kinematics. In selected patients, excessive tension or retraction of the pectoralis minor can induce scapular protraction and internal rotation, contributing to persistent shoulder pain and functional limitation. Rehabilitation remains the first-line treatment. However, some patients remain symptomatic despite appropriate conservative management.
In our recent study published in of Shoulder and Elbow Surgery, we evaluated isolated arthroscopic pectoralis minor tenotomy in patients with painful shoulder syndrome associated with scapular dyskinesis secondary to pectoralis minor retraction. Thirty-seven patients were included, with a mean follow-up of 19.9 months. Functional outcomes improved significantly : Constant score increased from 55.3 to 73.3, VAS pain decreased from 7.5 to 2.6, and SSV improved from 46.8 to 74.7. Active elevation also improved significantly, while external and internal rotations remained unchanged.
These findings suggest that, in carefully selected patients, arthroscopic pectoralis minor tenotomy may be an effective option when conservative treatment fails. But this must remain a highly selective indication. Pectoralis minor tenotomy should not become the “carpal tunnel release of the shoulder”: a procedure performed too quickly, too broadly, or without a precise understanding of the underlying mechanism. This is not a universal treatment for shoulder pain. It is a targeted procedure for a specific biomechanical and neuromotor condition : painful scapular dyskinesis related to pectoralis minor contracture. This may represent an early step toward a better understanding and treatment of neuromotor disorders of the shoulder, conditions in which pain and dysfunction cannot be explained solely by intra-articular or structural lesions. Further randomized studies with longer follow-up are needed to confirm the durability of these results.
Alexandre Lädermann Solenn Gain Alex Piedvache Flavio Bonnet Agence EBP Le réseau des Kinés Parisiens
Scapular dyskinesis is an alteration in scapular position and movement that disrupts glenohumeral kinematics. Among its causes, pectoralis minor retraction induces scapular protraction and internal rotation, altering shoulder biomechanics. Often asymptomatic, scapular dyskinesis may also cause pain....