Updated: 12/27/2021

Long Thoracic Nerve

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  • Snapshot
    • A 20-year-old man presents to his primary care physician due to pain affecting the right rhomboid and levator scapulae muscles. This is accompanied by weakness of the shoulder that impairs his performance during football practice at his university. A few days prior to presentation he was tackled at his lateral chest wall during a football game. Physical examination is significant for projection of the scapula from the thoracic wall when his arms are pushing against the wall.
  • Introduction
    • Anatomy
      • arises from the 5th, 6th, and 7th cervical nerve roots that innervates
        • the serratus anterior muscle
      • the long thoracic nerve is a pure motor nerve
    • Clinical correlate
      • injury to the long thoracic nerve results in
        • winging of the scapula which can be demonstrated when
          • the patient presses against the wall which leads to
            • the affected scapula projecting out
          • etiologies include
            • neuralgic amyotrophy
              • an inflammatory disorder affecting the brachial plexus
            • trauma to the nerve
              • examples include
                • a direct blow to the shoulder or the lateral chest wall (e.g., football)
                • surgical procedures such as
                  • resection of the first rib
                  • mastectomy with dissection of the axillary node
                  • infraclavicular plexus anesthesia
            • stretch or traction of the nerve can occur with
              • repetitive motion when doing sports or physical labor
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(M2.OR.17.4799) A 25-year-old man presents to his primary care physician for shoulder pain. He states that the pain has been ongoing for about a month. The patient is an avid weight lifter who is training for an upcoming weight lifting meet and states that the pain has affected his training. The patient has a past medical history of asthma which is managed with albuterol as needed. On physical exam, the patient has normal sensation in his upper extremities and 5/5 strength. Inspection of the patient's back is seen in Figure A. The patient is instructed to take at least one week off from weight lifting. Which of the following nerves is most likely injured in this patient?

QID: 109203
FIGURES:

Long thoracic

89%

(24/27)

Thoracodorsal

0%

(0/27)

Axillary

4%

(1/27)

Suprascapular

0%

(0/27)

Dorsal scapular

4%

(1/27)

M 6 E

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