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Long thoracic nerve palsy causes the scapula to protrude and can result in shoulder pain and loss of motion. It is often caused by direct injury or repetitive motion and can also involve the brachial plexus nerve. Diagnosis involves testing the electrical conductivity of the nerve and treatment options include physical therapy and surgery.
Long thoracic nerve palsy is caused by injury and damage to the long thoracic nerve. This nerve runs from the neck vertebrae along the side of the chest to the muscle that holds the scapula bone to the chest wall. When this nerve is damaged, the scapula — or scapula — becomes abnormally positioned, resembling a protruding wing. This strange placement has led to the name “winged scapula”. Shoulder pain and loss of motion occur as the imbalance in muscle functioning puts stress on the shoulder muscles.
Injuries to the long thoracic nerve may also involve the brachial plexus nerve. At one point above the collarbone, the two nerves run parallel to each other. If the injury occurs in this location, the brachial plexus, which runs the length of the arm, innervating the muscles of the arm and hand, may also be affected. Lesions near the vertebrae in the neck where these nerves originate can also affect both nerves, causing paralysis and loss of function in the arm and hand.
There are many possible causes of long thoracic nerve palsy, but most cases are due to direct injury or strenuous repetitive motion. The nerve runs fairly close to the surface and is easily affected by an impact to the upper body. Sports injuries are a common cause. Activities such as weight lifting, in which repetitive weight-bearing motion puts strain on the nerve, can also cause nerve damage. Surgical procedures, such as radical mastectomies and deep tissue massage, could also cause problems.
The long thoracic nerve passes through the scalenus medius muscle which connects the neck vertebrae to the first rib. Medical professionals believe that compression of this muscle can contribute to long thoracic nerve palsy. Muscle contraction and subsequent nerve damage can occur during exercise. This view is supported by the number of patients who develop this condition and who have a history of strenuous upper body activity. These include weight lifting or the lifting and carrying of heavy loads.
Diagnosis involves testing the electrical conductivity of the nerve using nerve conduction velocity testing or a similar procedure. Once nerve damage is detected, appropriate treatment is given. Nerve injuries can take a relatively long time to resolve and may only partially heal. Both physical therapy and surgery are used as treatments. Nerve decompression or surgical nerve transfer are possible treatment options.
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