The Long Thoracic Nerve is vulnerable to damage, probably because its anatomical course is long and exposed.
Disruption results only in winging of the scapula, that is, the shoulder-blade protrudes, no longer lies flat against the chest wall. Some sufferers report a preliminary and transient dull aching, but the nerve only contains motor (movement) fibres, so pain is not a feature.
| PRACTICE
POINT The cause of a Long Thoracic Nerve Palsy may be trauma or surgery, but is frequently unknown |
As with other nerves, direct traumatic[1], [2], [3] or surgical injury accounts for some cases, but spontaneous failure is characteristic of the Long Thoracic Nerve, and various mechanisms have been proposed[4]. Many occurrences are unexplained, and some follow general anesthesia[5] without recognised departure from standard nursing and anesthetic practice.
| PRACTICE
POINT Post-anesthesia cases for remote surgery are generally not caused by recognised substandard technique |
The paralysis is generally permanent[6], and may disable activities dependent on the stability of the shoulder girdle. Some sufferers are able to compensate by using other muscles[4].
| PRACTICE
POINT Therapy is generally ineffective, at least partial permanent disability usual |
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