Skip to main content

Long Thoracic Nerve Entrapment

  • Chapter

Abstract

The long thoracic nerve is under-recognized by pain specialists as a cause of shoulder pain and dysfunction. Unless it is specifically elicited, the hallmark winged scapula may go unnoticed. This chapter discusses the clinical presentation, physical exam, diagnostic features, and treatment options.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   249.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Thomas SE, Winchester JB, Hickman G, DeBusk E. A confirmed case of injury to the long thoracic nerve following a posterior approach to an interscalene nerve block. Reg Anesth Pain Med. 2013;38(4):370.

    Article  PubMed  Google Scholar 

  2. Srikumaran U, Wells JH, Freehill MT, Tan EW, Higgins LD, Warner JJ. Scapular winging: a great masquerader of shoulder disorders: AAOS exhibit selection. J Bone Joint Surg Am. 2014;96(14):e122.

    Article  PubMed  Google Scholar 

  3. Laulan J, Lascar T, Saint-Cast Y, Chammas M, Le Nen D. Isolated paralysis of the serratus anterior muscle successfully treated by surgical release of the distal portion of the long thoracic nerve. Chirurgie de la main. 2011;30(2):90–6.

    Article  CAS  PubMed  Google Scholar 

  4. Kuhn JE, Plancher KD, Hawkins RJ. Scapular winging. J Am Acad Orthop Surg. 1995;3(6):319–25.

    Article  CAS  PubMed  Google Scholar 

  5. Martin RM, Fish DE. Scapular winging: anatomical review, diagnosis, and treatments. Curr Rev Musculoskelet Med. 2008;1(1):1–11.

    Article  PubMed  Google Scholar 

  6. Tubbs RS, Salter EG, Custis JW, Wellons 3rd JC, Blount JP, Oakes WJ. Surgical anatomy of the cervical and infraclavicular parts of the long thoracic nerve. J Neurosurg. 2006;104(5):792–5.

    Article  PubMed  Google Scholar 

  7. Gregg JR, Labosky D, Harty M, Lotke P, Ecker M, DiStefano V, et al. Serratus anterior paralysis in the young athlete. J Bone Joint Surg Am. 1979;61(6a):825–32.

    Article  CAS  PubMed  Google Scholar 

  8. Vastamaki M, Kauppila LI. Etiologic factors in isolated paralysis of the serratus anterior muscle: a report of 197 cases. J Shoulder Elbow Surg. 1993;2(5):240–3.

    Article  CAS  PubMed  Google Scholar 

  9. Ebraheim NA, Lu J, Porshinsky B, Heck BE, Yeasting RA. Vulnerability of long thoracic nerve: an anatomic study. J Shoulder Elbow Surg. 1998;7(5):458–61.

    Article  CAS  PubMed  Google Scholar 

  10. Safran MR. Nerve injury about the shoulder in athletes, part 2: long thoracic nerve, spinal accessory nerve, burners/stingers, thoracic outlet syndrome. Am J Sports Med. 2004;32(4):1063–76.

    Article  PubMed  Google Scholar 

  11. Oware A, Herskovitz S, Berger AR. Long thoracic nerve palsy following cervical chiropractic manipulation. Muscle Nerve. 1995;18(11):1351.

    CAS  PubMed  Google Scholar 

  12. Murphy MT, Journeaux SF. Case reports: long thoracic nerve palsy after using a single axillary crutch. Clin Orthop Relat Res. 2006;447:267–9.

    Article  PubMed  Google Scholar 

  13. Lederman RJ. Focal peripheral neuropathies in instrumental musicians. Phys Med Rehabil Clin N Am. 2006;17(4):761–79.

    Article  PubMed  Google Scholar 

  14. Bizzarri F, Davoli G, Bouklas D, Oncchio L, Frati G, Neri E. Iatrogenic injury to the long thoracic nerve: an underestimated cause of morbidity after cardiac surgery. Tex Heart Inst J. 2001;28(4):315–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Gozna ER, Harris WR. Traumatic winging of the scapula. J Bone Joint Surg Am. 1979;61(8):1230–3.

    Article  CAS  PubMed  Google Scholar 

  16. Friedenberg SM, Zimprich T, Harper CM. The natural history of long thoracic and spinal accessory neuropathies. Muscle Nerve. 2002;25(4):535–9.

    Article  PubMed  Google Scholar 

  17. Mondelli M, Aretini A, Ginanneschi F. Predictive factors of recovery in long thoracic mononeuropathy. Orthopedics. 2013;36(6):e707–14.

    Article  PubMed  Google Scholar 

  18. Parsonage MJ, Turner JW. Neuralgic amyotrophy; the shoulder-girdle syndrome. Lancet. 1948;1(6513):973–8.

    Article  CAS  PubMed  Google Scholar 

  19. Foo CL, Swann M. Isolated paralysis of the serratus anterior. A report of 20 cases. J Bone Joint Surg (Br). 1983;65(5):552–6.

    CAS  Google Scholar 

  20. Nath RK, Lyons AB, Bietz G. Microneurolysis and decompression of long thoracic nerve injury are effective in reversing scapular winging: long-term results in 50 cases. BMC Musculoskelet Disord. 2007;8:25–32.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Horwitz MT, Tocantins LM. An anatomical study of the role of the long thoracic nerve and the related scapular bursae in the pathogenesis of local paralysis of the serratus anterior muscle. Anat Rec. 1938;71(4):375–85.

    Article  Google Scholar 

  22. Hester P, Caborn DN, Nyland J. Cause of long thoracic nerve palsy: a possible dynamic fascial sling cause. J Shoulder Elbow Surg. 2000;9(1):31–5.

    Article  CAS  PubMed  Google Scholar 

  23. Kauppila LI. The long thoracic nerve: possible mechanisms of injury based on autopsy study. J Shoulder Elbow Surg. 1993;2(5):244–8.

    Article  CAS  PubMed  Google Scholar 

  24. Hamada J, Igarashi E, Akita K, Mochizuki T. A cadaveric study of the serratus anterior muscle and the long thoracic nerve. J Shoulder Elbow Surg. 2008;17(5):790–4.

    Article  PubMed  Google Scholar 

  25. Disa JJ, Wang B, Dellon AL. Correction of scapular winging by supraclavicular neurolysis of the long thoracic nerve. J Reconstr Microsurg. 2001;17(2):79–84.

    Article  CAS  PubMed  Google Scholar 

  26. Nath RK, Melcher SE. Rapid recovery of serratus anterior muscle function after microneurolysis of long thoracic nerve injury. J Brachial Plex Peripher Nerve Inj. 2007;2:4.

    PubMed  PubMed Central  Google Scholar 

  27. Wiater JM, Flatow EL. Long thoracic nerve injury. Clin Orthop Relat Res. 1999;368:17–27.

    Google Scholar 

  28. Le Nail LR, Bacle G, Marteau E, Corcia P, Favard L, Laulan J. Isolated paralysis of the serratus anterior muscle: surgical release of the distal segment of the long thoracic nerve in 52 patients. Orthop Traumatol Surg Res. 2014;100(4s):S243–s8.

    Article  PubMed  Google Scholar 

  29. Hassan WU, Keaney NP. Winging of the scapula: an unusual complication of chest tube placement. J Accid Emerg Med. 1995;12(2):156–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Seror P. The long thoracic nerve conduction study revisited in 2006. Clin Neurophysiol. 2006;117(11):2446–50.

    Article  CAS  PubMed  Google Scholar 

  31. Watson CJ, Schenkman M. Physical therapy management of isolated serratus anterior muscle paralysis. Phys Ther. 1995;75(3):194–202.

    Article  CAS  PubMed  Google Scholar 

  32. Ramamurthy S, Hickey R, Maytorena A, Hoffman J, Kalantri A. Long thoracic nerve block. Anesth Analg. 1990;71(2):197–9.

    Article  CAS  PubMed  Google Scholar 

  33. Hanson NA, Auyong DB. Systematic ultrasound identification of the dorsal scapular and long thoracic nerves during interscalene block. Reg Anesth Pain Med. 2013;38(1):54–7.

    Article  PubMed  Google Scholar 

  34. Blanco R, Parras T, McDonnell JG, Prats-Galino A. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia. 2013;68(11):1107–13.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sola Olamikan MD .

Editor information

Editors and Affiliations

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Physical exam of the long thoracic nerve (MOV 26226 kb)

Landmark-guided injection of the long thoracic nerve (MOV 29564 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Olamikan, S., Karl, H.W. (2016). Long Thoracic Nerve Entrapment. In: Trescot, A.M. (eds) Peripheral Nerve Entrapments. Springer, Cham. https://doi.org/10.1007/978-3-319-27482-9_30

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-27482-9_30

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27480-5

  • Online ISBN: 978-3-319-27482-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics