LONG THORACIC NERVE PALSY
The long thoracic nerve of Bell (C5, 6,
7) may be damaged in shoulder or neck injuries (usually an axonotmesis) or
during operations such as first rib resection, transaxillary sympathectomy or
radical mastectomy. However, serratus anterior palsy is also seen after
comparatively benign events, such as carrying loads on the shoulder, and even
viral illnesses or toxoid injections.
Clinical features
Paralysis of serratus anterior is the
commonest cause of winging of the scapula. The patient may complain of aching
and weakness on lifting the arm. Examination shows little abnormality until the
arm is elevated in flexion or abduction. The classic test for winging is to
have the patient pushing forwards against the wall or thrusting the shoulder
forwards against resistance.
Treatment
Except after direct injury or division,
the nerve usually recovers spontaneously, though this may take a year or longer.
Persistent winging of the scapula occasionally requires operative stabilization
by transferring pectoralis minor or major to the lower part of the scapula.
Reference:
·
Apley’s System
of Orthopaedics and Fractures (Page- 280)
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