Long Thoracic Nerve Entrapment

  • Sola OlamikanEmail author
  • Helen W. Karl


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.


Long thoracic nerve Long thoracic neuralgia Winged scapula Shoulder pain 

Supplementary material

Video 30.1

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

Video 30.2

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


  1. 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.CrossRefPubMedGoogle Scholar
  2. 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.CrossRefPubMedGoogle Scholar
  3. 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.CrossRefPubMedGoogle Scholar
  4. 4.
    Kuhn JE, Plancher KD, Hawkins RJ. Scapular winging. J Am Acad Orthop Surg. 1995;3(6):319–25.CrossRefPubMedGoogle Scholar
  5. 5.
    Martin RM, Fish DE. Scapular winging: anatomical review, diagnosis, and treatments. Curr Rev Musculoskelet Med. 2008;1(1):1–11.CrossRefPubMedGoogle Scholar
  6. 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.CrossRefPubMedGoogle Scholar
  7. 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.CrossRefPubMedGoogle Scholar
  8. 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.CrossRefPubMedGoogle Scholar
  9. 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.CrossRefPubMedGoogle Scholar
  10. 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.CrossRefPubMedGoogle Scholar
  11. 11.
    Oware A, Herskovitz S, Berger AR. Long thoracic nerve palsy following cervical chiropractic manipulation. Muscle Nerve. 1995;18(11):1351.PubMedGoogle Scholar
  12. 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.CrossRefPubMedGoogle Scholar
  13. 13.
    Lederman RJ. Focal peripheral neuropathies in instrumental musicians. Phys Med Rehabil Clin N Am. 2006;17(4):761–79.CrossRefPubMedGoogle Scholar
  14. 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.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Gozna ER, Harris WR. Traumatic winging of the scapula. J Bone Joint Surg Am. 1979;61(8):1230–3.CrossRefPubMedGoogle Scholar
  16. 16.
    Friedenberg SM, Zimprich T, Harper CM. The natural history of long thoracic and spinal accessory neuropathies. Muscle Nerve. 2002;25(4):535–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Mondelli M, Aretini A, Ginanneschi F. Predictive factors of recovery in long thoracic mononeuropathy. Orthopedics. 2013;36(6):e707–14.CrossRefPubMedGoogle Scholar
  18. 18.
    Parsonage MJ, Turner JW. Neuralgic amyotrophy; the shoulder-girdle syndrome. Lancet. 1948;1(6513):973–8.CrossRefPubMedGoogle Scholar
  19. 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.Google Scholar
  20. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 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.CrossRefGoogle Scholar
  22. 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.CrossRefPubMedGoogle Scholar
  23. 23.
    Kauppila LI. The long thoracic nerve: possible mechanisms of injury based on autopsy study. J Shoulder Elbow Surg. 1993;2(5):244–8.CrossRefPubMedGoogle Scholar
  24. 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.CrossRefPubMedGoogle Scholar
  25. 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.CrossRefPubMedGoogle Scholar
  26. 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.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Wiater JM, Flatow EL. Long thoracic nerve injury. Clin Orthop Relat Res. 1999;368:17–27.Google Scholar
  28. 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.CrossRefPubMedGoogle Scholar
  29. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Seror P. The long thoracic nerve conduction study revisited in 2006. Clin Neurophysiol. 2006;117(11):2446–50.CrossRefPubMedGoogle Scholar
  31. 31.
    Watson CJ, Schenkman M. Physical therapy management of isolated serratus anterior muscle paralysis. Phys Ther. 1995;75(3):194–202.CrossRefPubMedGoogle Scholar
  32. 32.
    Ramamurthy S, Hickey R, Maytorena A, Hoffman J, Kalantri A. Long thoracic nerve block. Anesth Analg. 1990;71(2):197–9.CrossRefPubMedGoogle Scholar
  33. 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.CrossRefPubMedGoogle Scholar
  34. 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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Anesthesiology and Pain MedicineUniversity of Texas, Southwestern Medical CenterDallasUSA
  2. 2.Children’s Health Medical CenterDallasUSA
  3. 3.Department of Anesthesiology and Pain MedicineUniversity of Washington, Seattle Children’s HospitalSeattleUSA

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