Ultrasound-guided minimally invasive release of the pectoralis minor: Initial experience in cadaveric specimens

INTRODUCTION: Pectoralis minor syndrome results from excessive contraction or shortening of the pectoralis minor muscle, causing scapular dyskinesis, shoulder dysfunction, and potential neurovascular compression. Existing surgical treatments, including open and arthroscopic pectoralis minor releases, lack minimally invasive options. OBJECTIVE: To evaluate the feasibility, safety and efficiency of ultrasound-guided release of the pectoralis minor coracoid insertion in a cadaveric model. METHODS: A single-operator study was conducted on eight shoulders from four fresh cadavers. Under ultrasound guidance, the coracoid insertion of the pectoralis minor was visualized, and a minimally invasive release was performed using a specialized KEMIS© knife. The completeness of the tendon release was validated by open dissection. Operative times and potential injury to adjacent structures were recorded. RESULTS: Complete tendon sectioning was achieved in all specimens without injury to the brachial plexus, subclavian artery, or vein. Minor damage to anterior deltoid fibres (<10%) was noted in some shoulders. Localization times improved significantly (from 75 to 35 s), and tendon cutting times were consistently less than 20 s after the second procedure. CONCLUSION: Ultrasound-guided pectoralis minor muscle release is a safe, efficient, minimally invasive technique with a short learning curve. These findings warrant further studies to investigate its clinical applicability and long-term outcomes.