The latissimus dorsi tendon transfer is a surgical procedure used to restore shoulder function in patients with large, irreparable tears of the rotator cuff—particularly those involving the posterosuperior portion (upper and back side) of the shoulder. When the rotator cuff is too damaged to repair directly, surgeons may repurpose nearby muscles and tendons to take over its function. The latissimus dorsi, a strong back muscle typically involved in pulling movements, can be redirected to help restore shoulder motion.
How Common It Is and Who Gets It? (Epidemiology)
The latissimus dorsi tendon transfer is commonly performed in individuals with chronic, massive rotator cuff tears, especially in younger or more active patients who are not candidates for shoulder replacement. This surgery is often recommended for individuals who experience persistent pain and loss of function after attempting conservative treatments like physical therapy. It is particularly beneficial for patients with irreparable rotator cuff tears who want to avoid shoulder replacement surgery.
Why It Happens – Causes (Etiology and Pathophysiology)
The rotator cuff is made up of four muscles that help stabilize and move the shoulder. Over time, or due to trauma, the rotator cuff tendons may become torn or degenerated. When the damage is too extensive to repair using traditional surgical techniques, the shoulder loses its ability to perform certain movements, leading to pain and functional limitations. The latissimus dorsi tendon transfer provides an alternative solution by using the latissimus dorsi muscle, a large muscle in the back, to compensate for the lost function.
How the Body Part Normally Works? (Relevant Anatomy)
The rotator cuff muscles stabilize the humeral head (ball of the shoulder) within the glenoid (socket). The latissimus dorsi is a large, powerful muscle that helps move the arm, particularly during pulling movements like lat pulldowns and climbing. The latissimus dorsi tendon is usually attached to the upper arm bone, but in the latissimus dorsi tendon transfer procedure, it is rerouted to the shoulder to help restore lost motion, especially in external rotation and abduction.
What You Might Feel – Symptoms (Clinical Presentation)
Patients with massive rotator cuff tears typically experience weakness, pain, and difficulty lifting the arm or rotating it outward. Many also have difficulty with activities that require overhead motion, such as reaching or lifting. Symptoms may include shoulder weakness, pain during daily activities, and difficulty lifting the arm overhead, often made worse by repetitive shoulder use.
How Doctors Find the Problem? (Diagnosis and Imaging)
Diagnosis of rotator cuff tears involves a physical exam, where the physician assesses the range of motion, strength, and stability of the shoulder joint. Imaging studies like MRI or ultrasound are often used to evaluate the extent of the tear and determine if it is repairable. If the tear is large or irreparable, the latissimus dorsi tendon transfer may be considered as a treatment option.
Classification
Rotator cuff tears are classified based on their size and location:
- Small: Tears involving one tendon, often treatable with conservative measures.
- Medium to large: Tears involving two or more tendons, often requiring surgery.
- Massive: Extensive tears that cannot be repaired with standard techniques. These cases are where latissimus dorsi tendon transfer is most commonly used.
Other Problems That Can Feel Similar (Differential Diagnosis)
Other conditions that can cause shoulder weakness and pain include labral tears, shoulder instability, arthritis, and impingement syndrome. Accurate diagnosis requires distinguishing between these conditions through clinical evaluation and imaging studies.
Treatment Options
Non-Surgical Care
- Physical therapy to strengthen the shoulder and restore motion
- Anti-inflammatory medications or corticosteroid injections to alleviate pain and inflammation
- Activity modification to reduce strain on the shoulder
Surgical Care
- Latissimus dorsi tendon transfer: The tendon is harvested from the latissimus dorsi muscle and rerouted to the shoulder to restore function.
- Rotator cuff repair: In some cases, traditional rotator cuff repair may be possible if the tear is not too extensive.
- Shoulder replacement: For patients with irreparable rotator cuff tears and severe joint degeneration, shoulder replacement may be necessary.
Recovery and What to Expect After Treatment
Post-surgery recovery involves wearing a sling for several weeks to protect the new tendon attachment. Gradual physical therapy is crucial for regaining shoulder strength and motion. Full recovery may take several months, and patients typically return to light activities within 2–3 months, with full recovery, including overhead movements, occurring around 6–12 months.
Possible Risks or Side Effects (Complications)
Complications of the latissimus dorsi tendon transfer can include tendon rupture, infection, nerve injury, and failure of the tendon to heal properly. Some patients may experience residual weakness or pain, especially if the tendon does not integrate well with the shoulder. There is also a risk of discomfort or irritation from the hardware used to secure the tendon.
Long-Term Outlook (Prognosis)
The long-term prognosis for patients who undergo latissimus dorsi tendon transfer is generally positive, with most patients experiencing significant improvements in shoulder function and a reduction in pain. However, the success of the procedure depends on factors such as tendon healing, the patient’s rehabilitation adherence, and the condition of surrounding shoulder structures.
Out-of-Pocket Cost
Medicare
CPT Code 23395 – Latissimus Dorsi Tendon Transfer (Surgical Transfer of the Latissimus Dorsi Tendon for Shoulder Function Restoration): $304.12
Medicare Part B typically covers 80% of the approved cost for this procedure once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield usually cover that remaining 20%, significantly reducing or eliminating out-of-pocket expenses for Medicare-approved surgeries. These plans coordinate with Medicare to fill the coverage gap and reduce patient costs.
If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans generally cover any remaining balance, including coinsurance or small deductibles, which typically range from $100 to $300, depending on your plan and provider network.
Workers’ Compensation
If your latissimus dorsi tendon transfer is required due to a work-related injury, Workers’ Compensation will cover all associated medical expenses, including surgery, rehabilitation, and follow-up care. You will not have any out-of-pocket expenses, as the employer’s insurance carrier directly covers all approved treatments.
No-Fault Insurance
If your latissimus dorsi tendon transfer is needed due to an automobile accident or shoulder injury, No-Fault Insurance will typically cover the full cost of treatment, including surgery and postoperative care. The only potential out-of-pocket cost may be a small deductible or co-payment depending on your insurance policy.
Example
Laura Stevens required latissimus dorsi tendon transfer (CPT 23395) to restore shoulder function after a severe rotator cuff tear. Her estimated Medicare out-of-pocket cost was $304.12. Since Laura had supplemental insurance through Blue Cross Blue Shield, her remaining balance was fully covered, leaving her with no out-of-pocket expenses for the procedure.
Frequently Asked Questions (FAQ)
Q. What is a latissimus dorsi tendon transfer?
A. It is a surgical procedure used to restore shoulder function by transferring the latissimus dorsi tendon to a different location on the shoulder.
Q. When is a latissimus dorsi tendon transfer recommended?
A. It is recommended for patients with massive rotator cuff tears that cannot be repaired directly.
Q. What symptoms might lead to consideration of a latissimus dorsi tendon transfer?
A. Symptoms include shoulder pain, weakness, and limited ability to lift or rotate the arm.
Q. What does the latissimus dorsi muscle normally do?
A. The latissimus dorsi muscle helps in shoulder extension, adduction, and internal rotation.
Q. How does the latissimus dorsi help when transferred in surgery?
A. When transferred, it compensates for lost rotator cuff function and helps restore shoulder movement.
Q. Who is a good candidate for latissimus dorsi tendon transfer?
A. Good candidates are typically younger, active patients with irreparable posterosuperior rotator cuff tears and an intact subscapularis tendon.
Q. What imaging tests are used before the procedure?
A. MRI and X-rays are used to evaluate the shoulder and determine if the procedure is appropriate.
Q. How is the latissimus dorsi tendon transferred?
A. The tendon is detached from its original location and reattached to the humerus to replace the function of the torn rotator cuff tendons.
Q. What type of anesthesia is used during the procedure?
A. General anesthesia is used.
Q. How long does the surgery usually take?
A. The procedure typically takes 2 to 3 hours.
Q. What is the typical hospital stay after surgery?
A. Most patients stay in the hospital for one day.
Q. What is the post-operative care like after latissimus dorsi tendon transfer?
A. The arm is placed in a sling for several weeks, followed by physical therapy.
Q. When does physical therapy begin after surgery?
A. Physical therapy usually begins around six weeks after surgery.
Q. What are the goals of physical therapy after tendon transfer?
A. The goals include regaining range of motion, strength, and shoulder function.
Q. How long does recovery take after a latissimus dorsi tendon transfer?
A. Full recovery may take six months to a year.
Q. What are the potential risks or complications of the procedure?
A. Risks include infection, nerve injury, stiffness, or failure of the tendon transfer.
Q. How successful is the latissimus dorsi tendon transfer procedure?
A. It is generally successful in improving shoulder function and reducing pain in appropriately selected patients.
Q. Can the procedure restore full shoulder function?
A. It often improves function significantly but may not fully restore normal shoulder strength or motion.
Q. Are there any alternatives to this procedure?
A. Alternatives may include physical therapy, pain management, or reverse shoulder replacement, depending on the patient’s condition.
Summary and Takeaway
The latissimus dorsi tendon transfer is an effective solution for patients with irreparable rotator cuff tears, especially those who are not candidates for shoulder replacement. This procedure restores shoulder function, relieves pain, and allows patients to return to normal activities. Advances in surgical technique, such as the use of bone-to-bone fixation, have improved the success and durability of this procedure.
Clinical Insight & Recent Findings
A recent systematic review compared the clinical outcomes of latissimus dorsi tendon transfer (LDTT) and muscle advancement (MA) for irreparable rotator cuff tears (IRCTs). The study found that while both techniques effectively restored shoulder function, LDTT showed superior improvements in external rotation and lower rates of retear and failure (8.9% vs. 20.8% in the MA group).
Additionally, the MA group had a higher incidence of complications (25.7% vs. 18%), although both procedures had similar functional outcomes and pain relief. LDTT, involving dynamic biomechanical compensation by transferring the latissimus dorsi tendon to the shoulder, is particularly suitable for patients with significant tendon degeneration, while MA, which focuses on muscle advancement, excels in improving static stability.
The study emphasized the need for patient-specific surgical selection based on individual factors like age, activity level, and the extent of muscle degeneration. (“Study on tendon transfer vs. muscle advancement for IRCTs – see PubMed.”)
Who Performs This Treatment? (Specialists and Team Involved)
Orthopedic surgeons specializing in shoulder reconstruction typically perform latissimus dorsi tendon transfers. A rehabilitation team, including physical therapists, plays a key role in the postoperative recovery process.
When to See a Specialist?
Consult a specialist if you have persistent shoulder pain and weakness due to a massive rotator cuff tear that has not improved with conservative treatments.
When to Go to the Emergency Room?
Seek emergency care if you experience severe shoulder pain after an injury or if you notice signs of infection, such as fever or redness at the surgical site.
What Recovery Really Looks Like?
Recovery involves wearing a sling to protect the tendon, followed by physical therapy to restore range of motion and strength. Full recovery, including the ability to perform overhead movements, may take several months.
What Happens If You Ignore It?
If left untreated, a massive rotator cuff tear can lead to chronic pain, weakness, and decreased shoulder function. Over time, this may result in further joint degeneration, requiring more invasive procedures.
How to Prevent It?
Preventing rotator cuff tears involves strengthening shoulder muscles, using proper lifting techniques, and avoiding excessive overhead movements or trauma.
Nutrition and Bone or Joint Health
A diet rich in calcium, vitamin D, and omega-3 fatty acids supports joint health and helps reduce inflammation, aiding in recovery after surgery.
Activity and Lifestyle Modifications
Avoiding activities that strain the shoulder joint and focusing on strengthening the rotator cuff muscles can help prevent future injuries and maintain shoulder health.
