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PubMed1990

[A case of long thoracic nerve palsy, with winged scapula, as a result of prolonged exertion on practicing archery].

Reports of isolated long thoracic nerve palsy are rare in Japan. We reported a case of isolated long thoracic nerve palsy, resulted from recurrent injury to the nerve. Muscle CT and electrodiagnostic study were useful for confirming diagnosis of this cases. This patient was a student aged 20 years, with nothing of importance in his family or past history. After he started practicing archery, winging of left scapula was gradually developed. Physical examination revealed weakness and atrophy of left serratus anterior muscle. There was no wasting and weakness of other should girdle muscles. Hematochemical tests were normal, except slight hyperthyroidism. Radiography and myelography of the cervical spine were normal. Muscle CT of upper thoracic level demonstrated atrophy of left serratus anterior muscle, and no abnormality were found in other muscles. Electromyogram of the left serratus anterior revealed discrete activity of reduced amplitude, and fibrillation potentials and positive sharp waves. Conduction time for left long thoracic nerve was prolonged, and amplitude of the evoked response was small and there were temporal dispersion. Muscle CT and electrodiagnostic studies were suggestive of neuroapraxia of left long thoracic nerve. Over stretching or compression during exercises may be responsible for the damage to the long thoracic nerve.

Adult↗

PubMed2004

An isolated long thoracic nerve injury in a Navy Airman.

A palsy of the long thoracic nerve of Bell is a cause of scapular winging that has been reported after trauma, surgery, infection, electrocution, chiropractic manipulation, exposure to toxins, and various sports-related injuries that include tennis, hockey, bowling, soccer, gymnastics, and weight lifting. Scapular winging can result from repetitive or sudden external biomechanical forces that may either exert compression or place extraordinary traction in the distribution of the long thoracic nerve. We describe an active duty Navy Airman who developed scapular winging secondary to traction to the long thoracic nerve injury while working on the flight line. A thorough history and physical is essential in determining the mechanism of injury. Treatment should initially include refraining from strenuous use of the involved extremity, avoidance of the precipitating activity, and physical therapy to focus on maintaining range of motion and strengthening associated muscles, with most cases resolving within 9 months.

Adult↗

PubMed2002

Surgical treatment of a long thoracic nerve palsy.

A 17-year-old patient presented with a long thoracic nerve palsy following an idiopathic onset of weakness to the serratus anterior muscle. With no evidence of recovery 3.5 months following onset of serratus anterior weakness, the patient underwent a thoracodorsal to long thoracic nerve transfer to reinnervate the serratus anterior muscle. Follow-up examination 6.5 years following the nerve transfer revealed no scapular winging, full range of motion of the shoulder and no reported functional shoulder restriction. We conclude that a thoracodorsal to long thoracic nerve transfer results in good functional recovery of the serratus anterior muscle.

Adolescent↗

PubMed1986

Familial long thoracic nerve palsy: a manifestation of brachial plexus neuropathy.

Long thoracic nerve palsy causes weakness of the serratus anterior muscle and winging of the scapula. It is usually traumatic in origin. Isolated long thoracic nerve palsy has not been recognized as the major manifestation of familial brachial plexus neuropathy, but I have studied the syndrome in four members of three generations of one family. One individual suffered an episode of facial paresis. The inheritance pattern was autosomal dominant.

Adolescent↗

PubMed1987

Brachial muscles of dystrophic chick embryos atypically sustain interaction with thoracic nerves.

Previous analyses of experimental chick embryos of normal lineage demonstrate the inability of brachial muscles to sustain a successful union with foreign nerves derived from a thoracic neural tube segment transplanted to the brachial region at day 2 in ovo (day 2E). The present experiments were performed to determine if mutant chick embryos afflicted with hereditary muscular dystrophy would respond similarly to this experimental manipulation. Using the same criteria applied to our analysis of experimental normal embryos, our results demonstrated that dystrophic brachial muscles were capable of maintaining a compatible union with foreign thoracic nerves throughout the experimental period analysed. Significant muscle growth occurred, intramuscular nerve branches were maintained, motor endplates formed and wing motility was equivalent to that of unoperated dystrophic embryos. Thus, foreign nerves rejected by normal brachial muscles were accepted by brachial muscles of the mutant dystrophic embryo.

Animals↗

PubMed1982

Long thoracic nerve palsy: case report.

Although the incidence of isolated long thoracic nerve palsy following acute spinal trauma is rare, one such case is presented with discussion of injury and treatment. The patient is a young man with paraplegia whose hospitalization was prolonged due to isolated right long thoracic nerve palsy. Palsy resulted form overstretching this nerve while using an overhead trapeze. Diagnosis was confirmed by electrodiagnostic studies. Full recovery occurred after 6 months.

Adult↗

PubMed1989

Postoperative isolated dysfunction of the long thoracic nerve: a rare entity of uncertain etiology.

A "winged" scapula is a rare, poorly understood, and potentially disabling curiosity following anesthesia and surgery. It is produced by dysfunction of the long thoracic nerve and consequent paralysis of the serratus anterior muscle. A survey of senior anesthesiologists indicated a consistent lack of familiarity with the entity. This article presents six cases of postoperative long thoracic nerve palsy. In a literature review of 111 instances of long thoracic nerve palsy, 51 were trauma-related, 47 were either idiopathic or of debatable origin, and 13 appeared following a surgical or obstetrical procedure. Unprovable etiologic contentions were frequent. Considerations of the etiologies of postoperative long thoracic nerve palsies must include a coincidental infectious neuropathy ("neuralgic amyotrophy") as a valid alternative to the assertion that a preventable injury occurred during anesthesia.

Female↗

PubMedDate not supplied

Vulnerability of long thoracic nerve: an anatomic study.

The anatomic course of 40 long thoracic nerves was studied in relation to anatomic landmarks and reference lines, that is, the axillary lines and first 2 ribs. After its supraclavicular course, the nerve passes beneath the clavicle within the axillary sheath and then emerges from the axillary sheath. As it passes inferiorly and posteriorly from the point of emergence to the posterior angle of the second rib (that is, the attachments of serratus anterior muscle), it makes a posterior angle of 30.7 degrees +/- 4.3 degrees on average, relative to the anterior axillary line. It then continues to descend inferiorly between the middle and posterior axillary lines. When the arm is raised, the axillary neurovascular bundle moves superiorly with the movements of the arm. The long thoracic nerve is angulated and stretched at the point it passes out of the axillary sheath.

Adult↗

PubMed2006

Case reports: long thoracic nerve palsy after using a single axillary crutch.

We describe a 42-year-old patient who incurred long thoracic nerve palsy after using one axillary crutch. The patient sustained fractures to his left tibia and fibula. The fractures required internal fixation with a locked intramedullary nail and postoperative restricted weightbearing using axillary crutches. When weightbearing was progressed, the patient began using one axillary crutch on the right side. The resulting asymmetric gait pattern forced the crutch onto his chest wall, which led to right-sided long thoracic nerve palsy. The patient had not recovered 6 months after the injury. When providing axillary crutches, clinicians must consider potential compromise of the long thoracic nerve and the brachial plexus if the crutch is used inappropriately.

Adult↗

PubMed2000

[Injury of the long thoracic nerve after LRA, which etiology? Clinical case].

The long thoracic nerve supplies the serratus magnus muscle. Its injury causes "winging" of the scapula and functional limitation of the upper limb. Such lesion is mostly due to chronic trauma, occasionally iatrogenic. This case report presents a case of serratus magnus muscle paralysis following an anesthetic block of the brachial plexus performed at the time of a minor orthopedic surgery of the wrist, in a young healthy woman who was a tennis player. The observed lesion seemed to have been caused by the anesthetic technique employed, but, at the same time, it is impossible to rule out, in the etiology of the disease, a role of other predisposing factors, such as the intense sport activity above mentioned, or of concurrent factors, such as an incorrect position in the immediate postoperative period.

Adult↗

PubMed1995

The sensate deep inferior epigastric musculocutaneous flap and the twelfth thoracic nerve.

A detailed anatomical study of the terminal branches of the twelfth thoracic nerve (subcostal nerve) based on observations made during dissections of 23 embalmed cadavers is presented. In all 23 cadavers, the twelfth thoracic nerve had an ascending branch which joined the deep inferior epigastric vascular pedicle about half way between the lower border of the umbilicus and the symphysis pubis. This observation, we believe, explains how it is possible to preserve sensation in the deep inferior epigastric musculocutaneous flap.

Adolescent↗

PubMed1988

Electronmicroscopic and electrophysiological studies of the teat branch of the XIII thoracic nerve: relationship with lactation in the rat.

Electrical stimulation of the XIII thoracic nerve (the 'mammary nerve') causes milk ejection and the release of prolactin and other hormones. We have analysed the route of the suckling stimulus at the level of different subgroups of fibres of the teat branch of the XIII thoracic nerve (TBTN), which innervates the nipple and surrounding skin, and assessed the micromorphology of the TBTN in relation to lactation. There were 844 +/- 63 and 868 +/- 141 (S.E.M.) nerve fibres in the TBTN (85% non-myelinated) in virgin and lactating rats respectively. Non-myelinated fibres were enlarged in lactating rats; the modal value being 0.3-0.4 micron 2 for virgin and 0.4-0.5 micron 2 for lactating rats (P greater than 0.001; Kolmogorov-Smirnov test). The modal value for myelinated fibres was 3-6 micron 2 in both groups. The compound action potential of the TBTN in response to electrical stimulation showed two early volleys produced by the A alpha- and A delta-subgroups of myelinated fibres (conduction velocity rate of 60 and 14 m/s respectively), and a late third volley originated in non-myelinated fibres ('C') group; conduction velocity rate 1.4 m/s). Before milk ejection the suckling pups caused 'double bursts' of fibre activity in the A delta fibres of the TBTN. Each 'double burst' consisted of low amplitude action potentials and comprised two multiple discharges (33-37 ms each) separated by a silent period of around 35 ms. The 'double bursts' occurred at a frequency of 3-4/s, were triggered by the stimulation of the nipple and were related to fast cheek movements visible only by watching the pups closely. In contrast, the A alpha fibres of the TBTN showed brief bursts of high amplitude potentials before milk ejection. These were triggered by the stimulation of cutaneous receptors during gross slow sucking motions of the pup (jaw movements). Immediately before the triggering of milk ejection the mother was always asleep and a low nerve activity was recorded in the TBTN at this time. When reflex milk ejection occurred, the mother woke and a brisk increase in nerve activity was detected; this decreased when milk ejection was accomplished. In conscious rats the double-burst type of discharges in A delta fibres was not observed, possibly because this activity cannot be detected by the recording methods currently employed in conscious animals.(ABSTRACT TRUNCATED AT 400 WORDS)

Action Potentials↗

PubMed2000

Vascularized transplantation of the long thoracic nerve for sensory reinnervation of the lower lip.

Microsurgical techniques have improved functional and morphological reconstruction of the face in recent years. An important factor is the re-establishment of neuronal function. The aim of this study was a follow-up of the regeneration of sensation in the inferior alveolar nerve after partial resection of a tumour and reconstruction with a vascularized long thoracic nerve graft. Five patients were examined in monthly intervals to assess the degree of re-establishment of sensation. Pressure and pain responses were elicited as early as three months postoperatively, sense of touch and vibration were found after five months, and sensitivity to temperature after seven months postoperatively. In four patients nine months postoperatively, sensory qualities in the region of the mental nerve were identical on both sides. The vascularized long thoracic nerve is therefore an adequate nerve graft for covering defects as a result of resection of the inferior alveolar nerve patients with tumours.

Aged↗

PubMed2003

Repetitive stimulation of the long thoracic nerve in myasthenia gravis: clinical and electrophysiological correlations.

OBJECTIVE: To investigate repetitive stimulation of the long thoracic nerve as a reliable and technically undemanding method for evaluating respiratory muscle function in myasthenia gravis. METHODS: 15 patients with myasthenia gravis and positive single fibre electromyography had repetitive stimulation of the long thoracic nerve together with serratus anterior recordings. There were 20 normal controls. RESULTS: Eight patients with respiratory symptoms all had abnormal results, with an increased response decrement. These patients required intensive monitoring and supplemental oxygen. The remaining seven cases with no respiratory symptoms all had negative studies. CONCLUSIONS: This is a simple well tolerated method that shows good correlation with respiratory symptoms and management requirements in myasthenia gravis. It can alert the physician to serious respiratory complications in this disease.

Adolescent↗

PubMed1983

[Numbering of the dorsal spinal nerve roots in man from the 12th thoracic nerve to the coccygeal nerve].

A bilateral study for locating the dorsal root filaments of specific nerves was accomplished from the twelfth thoracic to the coccygeal level and this using 26 fetal and 8 adult specimens. After laminectomy from the thoracic to coccygeal levels, incision of the dural sac permitted visualisation of the dorsal root filaments, the successive rootlets corresponding to each segmental level (T12 to Co1 ) were counted with the aid of a binocular microscope where they penetrated the spinal medulla at the posterior sulcus. Statistical evaluation shows that for each dorsal nerve the average number of root filaments is greater on the right compared with the left. Numbering the dorsal nerve root filaments in the cephalo -caudal direction allows to assert with 99% probability up to the L5 level and with 95% probability up to the S1 level that one is at a given spinal level of the respective segmental range; caudal-cephalic direction numbering permits to affirm with 99% probability up to the S1 level and 95% probability up to the L4 level that one is at a given spinal level of the respective segmental range.

Fetus↗

PubMed2001

Compressive neuropathy of the brachial plexus and long thoracic nerve: a rare complication of heparin anticoagulation.

We present a case of a 69-year-old woman who developed brachial plexopathy and long thoracic nerve palsy secondary to compression from a hematoma while receiving heparin therapy for the treatment of a stroke. The patient was treated conservatively with discontinuation of heparin and had complete resolution of her compressive neuropathy. This is the first report of a patient with long thoracic nerve palsy with a brachial plexopathy complicating anticoagulation. We review the literature on hematoma-induced compressive neuropathies and treatment options. Our review concludes by emphasizing the importance of clinical judgment in determining the best therapeutic modality.

Aged↗

PubMedDate not supplied

Long thoracic nerve injury due to an electric burn.

A 19-year-old white man was burned over 7.5% of his body when he sustained an electric injury from a transformer. There was no associated fall or loss of consciousness. Debridement and grafting were required. The patient had some transient weakness of the muscles of his right arm associated with lower cervical nerve-root injury. This subsequently improved. He also was found to have paralysis of the serratus anterior muscle, with winging of the scapula due to long thoracic nerve injury. This has not improved. A surgical procedure suggested to improve function of the shoulder was rejected by the patient. This is only the second case reported of long thoracic nerve injury due to an electric burn of which we are aware.

Adult↗

PubMed1998

Scapula winger's brace: a case series on the management of long thoracic nerve palsy.

OBJECTIVE: To evaluate the clinical utility of a new scapula winger's brace. DESIGN: A case series. SETTING: A tertiary military clinic serving a young population. PARTICIPANTS: Fourteen patients referred to the clinic for thoracic nerve palsy of a least 3 months' duration. OUTCOME MEASURES: Manual muscle tests with and without the brace and patients' compliance/satisfaction with brace as measured by personal interview during follow-up. RESULTS: Muscle strength increased by one grade with brace application; patients who maintained compliance (n = 6) recovered their brace-free shoulder flexion strength and/or had reduced pain at the last follow-up (1 to 7 months after brace). All patients reported a subjective feeling of increased shoulder flexion strength and decreased pain with brace application. CONCLUSION: The scapula winger's brace is a useful tool for physiatrists in the management of scapular winging secondary to long thoracic nerve palsy. Additional studies are needed to confirm the conclusion that the device's benefits derive from proprioceptive feedback that prevents muscle overuse or overstretch and from its transfer of contralateral shoulder protraction force to the affected scapula.

Adult↗