The term mod quad is used to describe a surgical procedure adapted from the original quad surgery. The modified quad surgery is defined by the following procedures: 1. Latissimus dorsi contracture release and tendon transfer 2. Teres major contracture release and tendon transfer 3. Subscapularis muscle lengthening 4. Axillary nerve decompression & scar release 5. Anterior shoulder capsule release 6. Short head biceps release 7. Pectoralis minor release & lengthening 8.