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At least 55 records · Page 3Linked to original sources
PubMed2005

[The bilateral long thoracic nerve palsy presenting with "scapula alata", as a result of weight training. A case report].

A 28-year-old male barber with no similar disease in his family admitted to our hospital because of difficulty of raising his arms in March 2003. When he was 18 years old, he broke his left clavicle. He started weight training from January 2003, then he gradually felt difficulty to raise his arms. Physical examination on admission showed weakness and atrophy of both serratus anterior muscles and there was no weakness in the other muscles. Serum CK level was 806 IU/l and CT scan of the upper thoracic levels revealed atrophy of the serratus anterior muscles on the both sides. Needle electromyography showed neurogenic change in the right serratus anterior muscle. Thus the diagnosis of bilateral long thoracic nerve palsy was made. Bilateral scapular winging (scapula alata) is commonly caused by systemic disease, especially muscular dystrophy or spinal muscular atrophy. Bilateral long thoracic nerve palsy by weight training should be known as one of the cause for the "scapula alata".

Adult↗
PubMed1997

Simulation of cough in man by magnetic stimulation of the thoracic nerve roots.

Normal cough requires abdominal muscle contraction. We have previously reported contraction of the abdominal muscles elicited by a single percutaneous magnetic stimulation of the thoracic nerve roots. We hypothesized that paired magnetic twitches could generate sufficient tension in the abdominal muscles to simulate cough. Therefore, six normal subjects were stimulated at the T10 intervertebral level in the seated position. We measured the gastric pressure elicited by paired magnetic stimuli (pTw Pga) with interstimulus intervals in the range of 10 ms (100 Hz) to 999 ms (1 Hz). In the second part of the study we evaluated paired stimuli (at the frequency found to produce the greatest response) using a valve to simulate the function of the glottis; the valve was arranged such that it opened once mouth pressure exceeded a predetermined threshold. Mean pTw Pga during stimulation for the 6 subjects was 74 cm H2O (range, 30-109), and mean peak flow was 209 L/min (range, 128-345 L/min). These values were increased if the subject took a prior inspiration or had previously made a vigorous expiratory effort. Comparable values for a maximal natural cough were 212 cm H2O and 649 L/min. We conclude that paired magnetic thoracic nerve root stimulation produces gastric pressure and expiratory flow of an order of magnitude comparable to a natural cough.

Abdominal Muscles↗
PubMed2006

Surgical anatomy of the cervical and infraclavicular parts of the long thoracic nerve.

OBJECT: There is insufficient information in the neurosurgical literature regarding the long thoracic nerve (LTN). Many neurosurgical procedures necessitate a thorough understanding of this nerve's anatomy, for example, brachial plexus exploration/repair, passes for ventriculoperitoneal shunt placement, pleural placement of a ventriculopleural shunt, and scalenotomy. In the present study the authors seek to elucidate further the surgical anatomy of this structure. METHODS: Eighteen cadaveric sides were dissected of the LTN, anatomical relationships were observed, and measurements were obtained between it and surrounding osseous landmarks. The LTN had a mean length of 27 +/- 4.5 cm (mean +/- standard deviation) and a mean diameter of 3 +/- 2.5 mm. The distance from the angle of the mandible to the most proximal portion of the LTN was a mean of 6 +/- 1.1 cm. The distance from this proximal portion of the LTN to the carotid tubercle was a mean of 3.3 +/- 2 cm. The LTN was located a mean 2.8 cm posterior to the clavicle. In 61% of all sides the C-7 component of the LTN joined the C-5 and C-6 components of the LTN at the level of the second rib posterior to the axillary artery. In one right-sided specimen the C-5 component directly innervated the upper two digitations of the serratus anterior muscle rather than joining the C-6 and C-7 parts of this nerve. The LTN traveled posterior to the axillary vessels and trunks of the brachial plexus in all specimens. It lay between the middle and posterior scalene muscles in 56% of sides. In 11% of sides the C-5 and C-6 components of the LTN traveled through the middle scalene muscle and then combined with the C-7 contribution. In two sides, all contributions to the LTN were situated between the middle scalene muscle and brachial plexus and thus did not travel through any muscle. The C-7 contribution to the LTN was always located anterior to the middle scalene muscle. In all specimens the LTN was found within the axillary sheath superior to the clavicle. Distally, the LTN lay a mean of 15 +/- 3.4 cm lateral to the jugular notch and a mean of 22 +/- 4.2 cm lateral to the xiphoid process of the sternum. CONCLUSIONS: The neurosurgeon should have knowledge of the topography of the LTN. The results of the present study will allow the surgeon to better localize this structure superior and inferior to the clavicle and decrease morbidity following invasive procedures.

Axilla↗
PubMed2006

The long thoracic nerve conduction study revisited in 2006.

OBJECTIVE: To compare the reliability and feasibility of recording long thoracic nerve (LTN) conductions either with surface or needle electrodes. METHODS: The nerve conduction studies were carried out bilaterally on 40 control subjects. The LTN was first stimulated at the axilla and recorded with surface electrodes located on the 7th or 8th digitations of the serratus anterior (SA), then stimulated at Erb's point and recorded with a needle inserted in the 6th or 7th digitations of the SA. For each method, the latency and amplitude of the motor action potential were recorded. RESULTS: Responses were recorded on both sides for each patient. With surface recording, the mean latency was 2.2 +/- 0.30 ms, and the mean amplitude was 5.3 +/- 2.4 mV. With needle recording, the mean latency was 3.65 +/- 0.45 ms, and the mean amplitude was 8.95 +/- 4 mV. CONCLUSIONS: This study demonstrates that both techniques are reliable, feasible, and correlate well. SIGNIFICANCE: Our study shows surface recording of nerve conduction should be favored because it is non-traumatic, less uncomfortable for the patient, and less prone to pitfalls. Nevertheless, in pathological cases, both techniques should be used at initial and follow-up examinations in order to better assess axonal loss and nerve conduction impairment.

Adolescent↗
PubMed1975

Long thoracic nerve palsy: a follow-up study.

Twelve patients who had previously been treated for palsy of the long thoracic nerve of Bell and resultant serratus anterior paralysis were examined in a follow-up study designed to determine their extent of recovery and/or residual disability. The patients' histories were reviewed, following which they were recalled for updating of the history and reexamination. It was found that those patients whose lesions were due to acute trauma had only partial or no recovery of serratus function, while those with infectious, toxic, allergic or idiopathic etiologies had partial or complete recovery. The occurrence of a prolonged interval between onset of symptoms and institution of therapy was found to adversely affect prognosis. Among those patients with no recovery of serratus anterior function, some were able to maintain relatively good active motion in the affected shoulder by substituting with the trapezius.

Adolescent↗
PubMed2026

[Efficacy and safety of thoracic paravertebral block combined with thoracic nerve block for acute herpes zoster neuralgia involving upper thoracic dermatomes in middle-aged and elderly patients].

To investigate the clinical efficacy and safety of ultrasound-guided thoracic paravertebral block (TPVB) combined with pectoral nerve block (Pecs) in the treatment of acute herpetic neuralgia (AHN) involving the upper thoracic segments in middle-aged and elderly patients, a prospective study was conducted. A total of 70 middle-aged and elderly patients with upper thoracic AHN who visited the Department of Pain Medicine at Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, from June to December 2023, were enrolled and randomly divided into a control group and an experimental group using a random number table, with 35 patients in each group. The control group received TPVB once weekly for a total of 3 sessions, while the experimental group received TPVB combined with Pecs block using the same regimen. Outcome measures included the Visual Analogue Scale (VAS) for pain, Pittsburgh Sleep Quality Index (PSQI), 7-item Generalized Anxiety Disorder Scale (GAD-7), 9-item Patient Health Questionnaire (PHQ-9), treatment satisfaction score, incidence of postherpetic neuralgia (PHN), rescue analgesia, and adverse events. Assessments were conducted at 1, 4, 8, and 12 weeks post-treatment, and between-group differences were compared. Ultimately, 33 patients in the experimental group and 31 in the control group completed the follow-up and were included in the final analysis. The results showed that both groups demonstrated significant improvements in VAS scores, PSQI, GAD-7, PHQ-9, and satisfaction scores compared with baseline (all P<0.05). Compared with the control group, the experimental group exhibited significantly lower VAS scores and higher satisfaction scores at 1, 4, and 8 weeks post-treatment (P<0.05), as well as significantly lower PSQI, GAD-7, and PHQ-9 scores at 4 and 8 weeks (P<0.05). There were no statistically significant differences between the two groups in the incidence of PHN, rescue analgesia, or adverse events (all P>0.05). This study demonstrates that compared with TPVB alone, the combination of TPVB and Pecs block provides better pain relief, improves sleep quality, and alleviates anxiety and depression in middle-aged and elderly patients with upper thoracic AHN, with a favorable safety profile.

Humans↗
PubMed1984

Conduction studies of the long thoracic nerve in serratus anterior palsy of different etiology.

We studied nerve conduction in 24 patients with serratus anterior palsy of different etiology. On the unaffected control side, the latency of the evoked motor responses after stimulation of the long thoracic nerve in the supraclavicular fossa increased 0.2 msec per 10-mm increase in conduction distance, corresponding to a velocity of 67m-s. The method was valuable in determining whether the lesion was partial or complete and in revealing regeneration after wallerian degeneration.

Adolescent↗
PubMed2006

Myoclonus of the scapula after acute long thoracic nerve lesion: a case report.

We describe a patient who presented myoclonus in the left scapula 3 months after a traumatic lesion of the left long thoracic nerve. Myoclonic activity was recorded as pseudorhythmic electromyographic bursts repeated at a frequency of 2 to 4 Hz, each lasting between 100 and 200 msec, in the left serratus-dorsalis muscle region, trapezius, and deltoid muscles. A combination of peripheral and central mechanisms may have induced the myoclonus in this case.

Acute Disease↗
PubMed2000

[Applied anatomy of the transverse rectus abdominis musculocutaneous (TRAM) flap in relation to the eleventh or twelfth thoracic nerve].

OBJECTIVE: To observe the distribution of the terminal branches of the eleventh and twelfth thoracic nerve(T11, T12) for the anatomical basis and operation key points of the transverse rectus abdominis musculocutaneous(TRAM) flap with T11, T12. METHODS: The anterior abdominal wall was investigated through anatomical dissection in 22 embalmed cadavers. RESULTS: Cutaneous nerve distribution in the TRAM flap came mainly from T11, T12. They run obliquely between transverse abdominis and obliquus internus abdominis muscle. At the lateral edge of the rectus abdominis, they piece the anterior rectus sheath into the muscle. While supplying the muscle they pass on to supply the anterior rectus sheath and the overlying skin. CONCLUSION: It is possible to preserve T11, T12 in the TRAM flap, which would favour rapid return of flap sensation.

Female↗
PubMed1995

Rhythmic patterns in the thoracic nerve cord of the stick insect induced by pilocarpine

Bath application of the muscarinic agonist pilocarpine onto the deafferented stick insect thoracic nerve cord induced long-lasting rhythmic activity in leg motoneurones. Rhythmicity was induced at concentrations as low as 1x10(-4) mol l-1 pilocarpine. The most stable rhythms were reliably elicited at concentrations from 2x10(-3) mol l-1 to 5x10(-3) mol l-1. Rhythmicity could be completely abolished by application of atropine. The rhythm in antagonistic motoneurone pools of the three proximal leg joints, the subcoxal, the coxo-trochanteral (CT) and the femoro-tibial (FT), was strictly alternating. In the subcoxal motoneurones, the rhythm was characterised by the retractor burst duration being correlated with cycle period, whereas the protractor burst duration was almost independent of it. The cycle periods of the rhythms in the subcoxal and CT motoneurone pools were in a similar range for a given preparation. In contrast, the rhythm exhibited by motoneurones supplying the FT joint often had about half the duration. The pilocarpine-induced rhythm was generated independently in each hemiganglion. There was no strict intersegmental coupling, although the protractor motoneurone pools of the three thoracic ganglia tended to be active in phase. There was no stereotyped cycle-to-cycle coupling in the activities of the motoneurone pools of the subcoxal joint, the CT joint and the FT joint in an isolated mesothoracic ganglion. However, three distinct 'spontaneous, recurrent patterns' (SRPs) of motoneuronal activity were reliably generated. Within each pattern, there was strong coupling of the activity of the motoneurone pools. The SRPs resembled the motor output during step-phase transitions in walking: for example, the most often generated SRP (SRP1) was exclusively exhibited coincident with a burst of the fast depressor trochanteris motoneurone. During this burst, there was a switch from subcoxal protractor to retractor activity after a constant latency. The activity of the FT joint extensor motoneurones was strongly decreased during SRP1. SRP1 thus qualitatively resembled the motoneuronal activity during the transition from swing to stance of the middle legs in forward walking. Hence, we refer to SRPs as 'fictive step-phase transitions'. In intact, restrained animals, application of pilocarpine also induced alternating activity in antagonistic motoneurone pools supplying the proximal leg joints. However, there were marked differences from the deafferented preparation. For example, SRP1 was not generated in the latter situation. However, if the ipsilateral main leg nerve was cut, SRP1s reliably occurred. Our results on the rhythmicity in leg motoneurone pools of deafferented preparations demonstrate central coupling in the activity of the leg motoneurones that might be incorporated into the generation of locomotion in vivo.

Journal Article↗
PubMed1997

Of balloon axilloscopy and avoidance of iatrogenic injury to the long thoracic nerve.

BACKGROUND: Laparoscopic removal of axillary lymph nodes is possible and affords an excellent view of all structures, allowing preservation of vessels and nerves. The technique uses pediatric trocars and a lifting device to maintain the newly created axillary space. OBJECTIVE: To prove that a newly developed technique of balloon axilloscopy can be performed using only one 10-mm and two 5-mm standard trocars and constant carbon dioxide flow to preserve the axillary space and that preservation of all nerves and vessels is possible with this approach. DESIGN: Prospective study on 4 fresh-frozen human cadavers and 7 live porcine models. SETTING: A hospital department of minimal surgery access and a university department of anatomy. RESULTS: The balloon dissection consistently revealed and preserved the nerves and vessels, and exposure and dissection of the first rib could similarly be accomplished. An alternative route to the apex of the axilla has been developed--between the pectoralis minor and pectoralis major muscles--after their careful separation. The axillary content of surgical interest (lymph nodes) is easily separated from the other anatomical elements and is simply dissected under complete visualization and preservation of all vital axillary structures. CONCLUSIONS: Balloon axilloscopy was easy to perform, provided the surgeon with constant visualization of vital anatomical structures, and allowed easy separation and dissection of the axillary lymph nodes and the first rib. As a technical aid prior to a conventional axillary dissection, or as part of a pure endoscopic procedure in the axilla, balloon axilloscopy is 100% reliable in identifying the long thoracic nerve and moving it out of the way, separating the lymph nodes from it and from the intercostobrachial nerve and axillary vein and artery, rendering the whole dissection process safer for both the surgeon and the patient.

Animals↗