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PubMed1987

[Postoperatively developing serratus paresis as a legal problem].

It is demonstrated in five exemplary cases that a neuralgic amyotrophy with particular involvement of the long thoracic nerve was the cause of a postoperative serratus paresis. In any case liability claims, it is essential for an expert's opinion on postoperative serratus paresis to differentiate this pathology from intraoperative injuries caused by pressure. Above all the interval between operation and the first manifestation of symptoms, as well as the development of distinct pain count against an intraoperative plexus lesion.

Adult↗
PubMed2005

A novel technique for recording from the serratus anterior.

OBJECTIVE: To design an electrodiagnostic technique by which to accurately record the serratus anterior compound muscle action potential (CMAP). DESIGN: Observational study. SETTING: Academic electromyography laboratory. PARTICIPANTS: Fifteen healthy volunteers. INTERVENTIONS: The long thoracic nerve was stimulated by using a standard bipolar surface electrode in the axilla, just anterior to the midaxillary line. The serratus anterior CMAP was recorded by using a self-adhesive, 8.0 x 0.5 cm, ring electrode as the E1 placed across the serratus anterior interdigitations starting at the nipple level. A self-adhesive, motor (1 x 1 cm) electrode was used as E2 and placed over the seventh rib. A standard self-adhesive ground electrode was placed over the inferior region of the latissimus dorsi. MAIN OUTCOME MEASURES: Distal motor latency (DML), and CMAP amplitude and duration. RESULTS: After removing 2 outliers, the results are reported as the mean +/- 1.96 standard deviations. Right long thoracic DML was 2.2+/-1.0ms and the left was 2.3+/-0.9ms, with a side-to-side mean difference of 0.3+/-0.4ms. The right serratus CMAP amplitude was 3.8+/-3.9mV and the left was 3.9+/-3.7mV, with a side-to-side mean difference of 0.6+/-1.2mV. Statistical analysis did not reveal a significant side-to-side difference for DML or CMAP amplitude. Both sides were combined to form a single set of trials for DML and CMAP amplitude. The mean DML became 2.2+/-0.7ms, and the CMAP amplitude was 3.5+/-1.9mV. The CMAP duration was 14.5+/-4.3ms on the right and 14.5+/-4.1ms on the left. A significant, positive correlation existed between height and DML ( P <.02). The 95% confidence intervals for DML and CMAP amplitudes were 2.1 to 2.5ms and 1.5 to 3.1mV, respectively. CONCLUSIONS: Our latency, side-to-side comparisons and amplitude data were consistent with other motor nerve conduction findings in the literature. Stimulating the long thoracic nerve in the axilla will provide a reliable technique to aid in the diagnosis and treatment of long thoracic neuropathy.

Action Potentials↗
PubMed1989

Cutaneous branches from the dorsal rami of the cervical nerves, with emphasis on their positional relations to the semispinalis cervicis.

The courses of the cutaneous branches arising from the dorsal rami of the cervical and the upper thoracic nerves were examined on 61 sides in 31 human adults, and their positional relations to the semispinalis cervicis muscle were particularly noted. Absence of the cutaneous branch from the dorsal rami of the lower cervical nerves was observed in 60 of the 61 cases; and in the one remaining case, all the cervical nerves except C1 gave off a cutaneous branch. A difference in course of the cutaneous branches was clearly observed between those from the upper cervical and the upper thoracic segments. That is, those of the former passed superficial to the semispinalis cervicis, whereas those of the latter were situated deep to it. The absence of cutaneous branches of the lower cervical segments could be classified into two types: continuous absence and alternate absence. In the former, which was observed in 53 cases (87%), cutaneous branches were absent in continuous segments. In the latter, which was observed in 7 cases (11%), they were absent in alternate segments. Dermatome problems are discussed on the basis of the present results. Keegan-Garrett's chart could be supported in the one exceptional case only.

Cervical Plexus↗
PubMed1990

Mapping of serotonin-like immunoreactivity in the ventral nerve cord of crayfish.

Whole-mount immunohistochemical technique using antibody to serotonin (5-HT) had been used to map presumptive serotoninergic structures in the ventral abdominal and thoracic nerve cord of crayfish Procambarus clarkii. 5-HT immunoreactivity was detected in more than 30 cell bodies, numerous fibers and peripheral nerve endings of root plexus and neuropilar regions. Immunoreactive fibers are arranged in 3 pairs of rostrocaudal bundles. The median (MFB) and the lateral fiber bundles run longitudinally through the entire thoracic and abdominal nerve cord (first thoracic T1 to sixth abdominal A6 ganglia). The central (CFB) fiber bundles extend only from the subesophageal to the fourth thoracic ganglia. In the 4 anterior thoracic ganglia (T1-T4), two lateroposterior cell bodies send their major processes in the ipsilateral MFB. In the fifth thoracic (T5) and first abdominal (A1) ganglia, the pattern of reactive structures is similar. Two large anterior cells which send a single prominent process to join the ipsilateral MFB and 4 smaller posterior cells. In other abdominal ventral ganglia, immunoreactive structures are smaller and less labeled. Cell bodies are displayed in two kinds of arrangement giving the appearance of two distinct homogeneous groups of ganglia: an anterior group (A2-A3-A4) that contained two pairs of small neurons and a posterior group (A5-A6) that contained only a large unpaired medial neuron. These results were discussed in relation to the serotonin-like immunoreactivity pattern previously described in lobster by Beltz and Krawitz.

Animals↗
PubMed1999

[Paralysis of the M. serratus anterior as an occupational disease in a scaffolder].

A 30-year-old scaffolder developed acute shoulder complaints after lifting a heavy weight. There was complete failure of the long thoracic nerve resulting in a serratus anterior muscle palsy on the right side. Physical examination revealed only right scapula winging. A combination of stretching of the nerve and high mechanical pressure on the nerve had probably been the cause of this occupational injury. The shoulder complaints remained, resulting in disability and unemployment.

Adult↗
PubMed1987

Neuralgic amyotrophy: an increasingly diverse entity.

We describe nine cases of neuralgic amyotrophy whose clinical and electrophysiologic findings suggest lesions of individual peripheral nerves or peripheral nerve branches occurring singly (mononeuropathy) or in various combinations (mononeuropathy multiplex). There were four occurrences of isolated denervation of the pronator teres muscle; four occurrences of anterior interosseous nerve lesions; three occurrences of lateral antebrachial cutaneous nerve lesions; two occurrences of long thoracic nerve lesions; and one occurrence each of a median nerve trunk lesion, a median palmar cutaneous branch lesion, a suprascapular nerve lesion, and an axillary nerve lesion. "Neuralgic" pain was a prominent feature in all cases, and the location of the pain correlated with the location of the nerve lesions. We hypothesize that the specific course of certain nerves (especially their location across joints) selectively exposes them to mild focal trauma that increases their susceptibility to this disease. Whatever the etiology, this entity is considerably more diverse than generally appreciated.

Adult↗
PubMed1977

Reflex effects of thoracic sympathetic afferent nerve stimulation on the kidney.

Thoracic sympathetic afferents may play a role in the reflex control of renal vascular resistance during hypotension. Mongrel dogs were anesthetized with ketamine hydrochloride and maintained on a 50-50, O2-N2O mixture supplemented with 0.5%-1.0% halothane. Systemic arterial blood pressure was lowered to 50 mmHg with use of a constant pressure hemorrhage technique. The renal circulation was perfused with a constant-flow perfusion system. Low-frequency (3 Hz) stimulation of thoracic sympathetic afferents produced renal vasodilation. A reduction of renal vascular resistance was measured as a decrease in constant-flow perfusion pressure. Vagotomy accentuated the dilator response to stimulation. High-frequency (30 Hz) afferent stimulation produced renal vasoconstriction. Renal efferent nerve activity and renal blood flow responded to afferent stimulation (3 Hz) by transient inhibition of efferent activity and increases in renal blood flow. Afferent stimulation (30 Hz) caused increases in renal efferent nerve activity and decreases in renal blood flow. The thoracic sympathetic afferents carry information from cardiopulmonary structures that alter renal efferent nerve activity and renal hemodynamics during hypotension.

Animals↗
PubMed2006

Clinical signs of accessory nerve palsy.

BACKGROUND: Injury to the spinal accessory nerve causes paralysis of the trapezius muscle, which is a painful and disabling condition. Many injuries are iatrogenic. Diagnosis is often made after a long delay, suggesting that current clinical signs are inadequate. METHODS: Accessory nerve palsy is known to be a cause of winging of the scapula. Observation of six patients with accessory nerve palsy has shown that winging of the scapula is most prominent when the patient actively externally rotates the shoulder against resistance. RESULTS: This is in contrast to the other causes of winging of the scapula including long thoracic nerve palsy and muscular dystrophy, where the scapula is most prominent on flexion or abduction of the shoulder. CONCLUSION: We propose that the resisted active external rotation test should be regarded as the key clinical sign for accessory nerve palsy.

Accessory Nerve Diseases↗
PubMed2006

Winged scapula caused by rhomboideus and trapezius muscles rupture associated with repetitive minor trauma: a case report.

We experienced a rare case of winged scapula that was caused by the rupture of the rhomboideus major and the lower trapezius muscles without any nerve injury in a 12 yr old female after she had carried a heavy backpack. Electrodiagnostic study revealed that the onset latencies, amplitudes and conduction velocities were normal in the long thoracic nerve, the spinal accessory nerve and the dorsal scapular nerve. The needle EMG findings were normal as well. An explorative operation was performed and the rupture of the rhomboideus major and lower trapezius muscles was detected. Direct surgical repair of the ruptured muscle was carried out and the deformity was corrected. The anatomical and functional restoration was satisfactorily accomplished.

Child↗
PubMed1983

The development and postnatal organization of motor nuclei in the rat thoracic spinal cord.

The topographic organization of the motor nuclei supplying individual thoracic muscles in postnatal rats was investigated by horseradish peroxidase (HRP) labelling from the periphery. To determine whether aspects of the same organization are apparent at early developmental stages, we used HRP to label neurons contributing axons to the two primary rami of thoracic nerves in rat fetuses ranging in age from the 13th day of gestation to birth. This developmental period includes stages during which peripheral nerves and muscles are forming. The results show that motoneurons in the appropriate positions in the ventral horn have axons in each primary ramus even at stages prior to the innervation of muscle. However, in fetuses at certain developmental stages, there are also neurons located outside the motor nuclei which send axons into the peripheral nerves.

Animals↗
PubMed1996

An anatomical analysis of the relationships between the intercostal nerves and the thoracic and abdominal muscles in man. I. Ramification of the intercostal nerves.

Minute dissection was performed on the ventral primary rami of the first thoracic to first lumbar nerves in two halves of an adult male cadaver in order to determine points of origins of muscular branches from the intercostal nerves. Generally, the muscular branches originated independently, but the branches supplying the intercostalis intimus and internus tended to originate as a common trunk. The muscular branching patterns were compiled in an illustration, and based on these patterns the serial homology of the thoracic and abdominal muscles was proposed. Although the obliquus externus abdominis has been thought to correspond to the intercostales externi, from these innervation findings it appears to correspond to the intercostales interni. Further, the quadratus lumborum seems homologous to the intercostales externi.

Anatomy, Comparative↗
PubMed2007

Differential control of the scapulothoracic muscles in humans.

The control of the scapulothoracic muscles trapezius (Tr) and serratus anterior (SA) has been examined in normal human subjects. Electromyographic recordings were made from the SA and Tr muscles (upper trapezius UTr, lower trapezius LTr) using surface electrodes placed bilaterally. Magnetic stimulation of the motor cortex and electrical stimulation of peripheral nerves were used to examine their descending and reflex control. The average optimal site of cortical stimulation was found to be the same for SA, UTr and LTr (an approximate centre of gravity of -0.6 cm, 3.7 cm where the centre of gravity is expressed as the mean anterio-posterior position, the mean medio-lateral position). Some asymmetry in the cortical representation of UTr was found in each individual tested. Magnetic stimulation evoked bilateral MEPs in Tr (latency contralateral (c) UTr 8.5 +/- 1.6 ms, ipsilateral (i) UTr 19.0 +/- 2.7 ms) but only contralateral responses were evoked in SA (11.2 +/- 2.6 ms). Electrical stimulation of the long thoracic nerve at two sites was used to examine homonymous and heteronymous reflexes of SA, while electrical stimulation of cervical nerve of C3/4 was used to examine the heteronymous reflexes of Tr. Ipsilateral SA H reflexes were evoked at a latency of 9.9 +/- 0.8 ms (proximal site) and 10.8 +/- 1.2 ms (distal site). No group I reflexes were evoked from SA to its contralateral homologue. No group I reflexes were evoked between Tr and SA. Finally, cross-correlation of activity from the Tr muscle pairs and the SA muscle pair revealed that the motoneurones of the Tr muscles share some common presynaptic input whereas there was no detectable common presynaptic input to the SA muscle pair. This study extends and consolidates knowledge regarding the neural control of trapezius and for the first time explores the neural control of SA. The study demonstrates a contrasting bilateral control of Tr and SA. These patterns of connections are discussed in relation to the contrasting bilateral functional roles of these muscles.

Adult↗
PubMed1977

Neural repair for sensory restoration in a groin flap.

A preliminary study of the recovery of sensation in groin flaps, after suture of the lateral cutaneous branches of the twelfth thoracic nerve supplying the groin flap with those of the hand, is described. This appears to be a worthwhile procedure.

Abdomen↗
PubMed2002

[A winged scapula].

Three patients, one woman aged 22 and two men aged 54 and 28, presented with scapular winging. In the first patient amyotrophic plexus neuralgia was diagnosed. The second patient most probably suffered from a stretch injury of the long thoracic nerve. The third patient had scapular winging due to an isolated paresis of the trapezius muscle, which was caused by an idiopathic lesion of the accessory nerve. In the first and second patient an improvement was noticeable after 9 months and 1.5 years respectively. There was no improvement in the third patient after 11 years. Paresis of the M. serratus anterior occurs due to paralysis of the N. thoracicus longus, as a result of direct compression, stump trauma, interventions such as thoracic operations, (repeated) stretch injuries or neuralgic brachial plexus amyotrophy; in these cases the scapular winging increases as the arm is lifted forwards. Paresis of the M. trapezius occurs due to the paralysis of the N. accessorius, due to trauma, interventions such as in the neck area, a space-occupying abnormality or an idiopathic abnormality; in these cases the scapular winging increases upon the arm being lifted sideways. Another possible cause of scapular winging is muscular dystrophy, especially fascioscapulohumeral muscular dystrophy (FSHD). Usually the prognosis for recovery from a neuropraxia and an idiopathic lesion of the N. thoracicus longus within a two-year period is good. The prognosis for an isolated lesion of the N. accessorius is much less favourable. An EMG is essential for establishing a diagnosis.

Adult↗
PubMed1989

[Malignant tumor with peripheral neuropathy as presenting symptom--clinical analysis of 52 cases].

Fifty-two cases of malignant tumors with peripheral neuropathy as presenting symptom are reported. The duration of the peripheral neuropathy varied from 2 to 11 months before the malignant tumors were confirmed. The initial peripheral neuropathy included cranial nerve, sciatic nerve, intercostal nerve, brachial plexus, multiple peripheral nerves, thoracic outlet syndrome, polyneuritis, peripheral neuritis, autonomic nerve and Horner's syndrome. Most of these malignant tumors were lung cancer, nasopharyngeal cancer and hepatic carcinoma in order of incidence. Pathogenesis, clinical features, diagnosis and treatment of these tumors are discussed with review of the literature. The author emphasizes that if there was peripheral neuropathy of unknown cause, examination has to be done in detail and repeatedly for early diagnosis and better result.

Adult↗
PubMed1994

Posterolateral arthroscopic discectomies of the thoracic and lumbar spine.

Posterolateral arthroscopic discoscopies were performed on the lumbar and thoracic spine of the cadaver of a 6-foot-tall man. The purpose of this study was to determine the anatomic relationships of the discotomies and to examine the feasibility of the procedure for thoracic discectomies. At most levels in the thoracic spine, the rib neck acted as a guide to the posterolateral disc and as a safeguard against penetration of the pleural cavity. The average distance from the dura to the discotomy was 0.79 cm, with this distance increasing caudally. The thoracic nerve roots were found, in general, to be at less risk of damage because of their initial posterolateral course as they entered the subcostal groove. In the lumbar spine, the average distance from discostomy to the dura was 11.5 mm. Access to the triangular working zone could be gained with angles of insertion ranging from 38 degrees to 65 degrees. At angles less than 35 degrees, there was a significant risk of nerve injury. It is concluded that some thoracic discs can be safely removed through this approach and that the lumbar ventral ramii are very vulnerable to injury because of their proximity to the annulotomy.

Diskectomy↗