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Shoulder internal rotation deformity may be managed by shoulder fusion in severe cases. In less severe cases in which there is dynamic instability, release or lengthening of the subscapularis and/or pectoralis major will improve passive range of motion. Transfer of the latissimus dorsi and teres major to the posterolateral humerus will improve active external rotation. (The panel on the right shows Z-lengthening of the pectoralis major.)