The medial pectoral nerve arises from the medial cord of the brachial plexus (C8, T1) and pierces the pectoralis minor to supply both pectoralis minor and the lower portion of pectoralis major. At shoulder level it passes through or around the pectoralis minor near the coracoid process.
The medial pectoral nerve is at risk during pectoralis minor tenotomy for coracoid impingement and during subpectoral biceps tenodesis. Injury produces lower pectoralis major weakness and pectoralis minor denervation. It is preserved during the deltopectoral approach by identifying and protecting it at the pectoralis minor border. EMG distinguishes medial from lateral pectoral nerve involvement, guiding the level of brachial plexus injury.
Injury to the medial pectoral nerve during coracoid procedure or subpectoral surgery producing lower pectoralis major weakness and loss of shoulder adduction force.
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