II. Anatomy

  1. Long Thoracic Nerve forms from C5-7 nerve roots at the middle scalene muscle

III. Causes

  1. Direct blow to Shoulder
  2. Direct blow to pectoralis muscle at rib 4-5 at nerve exit site
  3. Chronic repetitive overhead Shoulder traction (e.g. tennis, volleyball, swimming, baseball)
  4. Traction injury at the middle scalene muscle
  5. Radical Mastectomy

IV. Symptoms

  1. Diffuse Shoulder or Neck Pain with overhead activity

V. Signs

  1. Forward flexion weakness at Shoulder
  2. Scapular winging

VI. Diagnostics

  1. Nerve Conduction Studies and EMG
  2. Shoulder MRI
    1. Not typically indicated but may show supraspinatus and infraspinatus denervation changes

VII. Management

  1. Shoulder Range of Motion Exercises
    1. Prevents Frozen Shoulder and contractures
  2. Strengthen remaining Shoulder stabilizing muscles
    1. Trapezius Muscles
    2. Rhomboid Muscles
    3. Levator Scapula Muscle
  3. Surgery is rarely indicated
    1. Consider surgery for Penetrating Trauma with nerve transection
    2. Consider surgery for lack of improvement at 18 to 24 months

VIII. Course

  1. Therapy leads to recovery times typically of 9-12 months (may require up to 2 years)

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Related Studies

Ontology: Long thoracic nerve injury (C0434255)

Concepts Injury or Poisoning (T037)
SnomedCT 212291002
English Long thoracic nerve injury, Long thoracic nerve injury (disorder)
Spanish lesión traumática del nervio torácico largo (trastorno), lesión traumática del nervio torácico largo

Ontology: Long thoracic nerve lesion (C0574905)

Concepts Disease or Syndrome (T047)
SnomedCT 298119007
English Long thoracic nerve lesion, Long thoracic nerve lesion (disorder)
Spanish lesión del nervio torácico largo (trastorno), lesión del nervio torácico largo

Ontology: Long thoracic nerve palsy (C2062708)

Concepts Disease or Syndrome (T047)
English nerve palsy long thoracic, long thoracic nerve palsy (diagnosis), long thoracic nerve palsy, Long thoracic nerve palsy
Spanish Parálisis del nervio torácico largo
Dutch nervus thoracicus longus verlamming
German Laehmung des Nervus thoracicus longus
Japanese チョウキョウシンケイマヒ, 長胸神経麻痺
Czech Obrna dlouhého torakálního nervu
Portuguese Paralisia do nervo torácico longo
Italian Paralisi del nervo toracico lungo
French Paralysie du nerf thoracique long
Hungarian Hosszú mellkasi ideg bénulása