Measuring myoelectric fatigue of the serratus anterior in healthy subjects and patients with long thoracic nerve palsy

Background: Isolated long thoracic nerve palsy results in scapular winging and destabilization. In this study, we review the surgical management of isolated long thoracic nerve palsy and suggest a surgical technique and treatment algorithm to simplify management. Methods: In total, 19 patients who required surgery for an isolated long thoracic nerve palsy were reviewed retrospectively. Preoperative demographics, electromyography (EMG), and physical examinations were reviewed. Intraoperative nerve stimulation, surgical decision making, and postoperative outcomes were reviewed. Results: In total, 19 patients with an average age of 32 were included in the study. All patients had an isolated long thoracic nerve palsy caused by either an injury (58%), Parsonage-Turner syndrome (32%), or shoulder surgery (10%); 18 patients (95%) underwent preoperative EMG; 10 with evidence of denervation (56%); and 13 patients had motor unit potentials in the serratus anterior (72%). The preoperative EMG did not correlate with intraoperative nerve stimulation in 13 patients (72%) and did correlate in 5 patients (28%); 3 patients had a nerve transfer (3 thoracodorsal to long thoracic at lateral chest, 1 pec to long thoracic at supraclavicular incision). In the 3 patients who had a nerve transfer, there was return of full forward flexion of the shoulder at an average of 2.5 months. Conclusions: A treatment algorithm based on intraoperative nerve stimulation will help guide surgeons in their clinical decision making in patients with isolated long thoracic nerve palsy. Intraoperative nerve stimulation is the gold standard in the management of isolated long thoracic nerve palsy.

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“Isolated long thoracic nerve palsy”: More than meets the eye

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2017.06.020 ◽

2017 ◽

Vol 70 (9) ◽

pp. 1272-1279 ◽

Cited By ~ 5

Author(s):

Andrés A. Maldonado ◽

Scott L. Zuckerman ◽

B. Matthew Howe ◽

Michelle L. Mauermann ◽

Robert J. Spinner

Keyword(s):

Nerve Palsy ◽

Long Thoracic Nerve ◽

Thoracic Nerve

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Radiation-induced long thoracic nerve palsy

Cancer ◽

10.1002/1097-0142(19870915)60:6<1247::aid-cncr2820600615>3.0.co;2-r ◽

1987 ◽

Vol 60 (6) ◽

pp. 1247-1248 ◽

Cited By ~ 17

Author(s):

Gale N. Pugliese ◽

Ronald F. Green ◽

Anthony Antonacci

Keyword(s):

Nerve Palsy ◽

Long Thoracic Nerve ◽

Thoracic Nerve ◽

Radiation Induced

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Surgical anatomy of the cervical and infraclavicular parts of the long thoracic nerve

Journal of Neurosurgery ◽

10.3171/jns.2006.104.5.792 ◽

2006 ◽

Vol 104 (5) ◽

pp. 792-795 ◽

Cited By ~ 21

Author(s):

R. Shane Tubbs ◽

E. George Salter ◽

James W. Custis ◽

John C. Wellons ◽

Jeffrey P. Blount ◽

...

Keyword(s):

Brachial Plexus ◽

Axillary Artery ◽

Surgical Anatomy ◽

Proximal Portion ◽

Neurosurgical Procedures ◽

Serratus Anterior ◽

Long Thoracic Nerve ◽

Scalene Muscle ◽

Thoracic Nerve ◽

Two Sides

Object There is insufficient information in the neurosurgical literature regarding the long thoracic nerve (LTN). Many neurosurgical procedures necessitate a thorough understanding of this nerve's anatomy, for example, brachial plexus exploration/repair, passes for ventriculoperitoneal shunt placement, pleural placement of a ventriculopleural shunt, and scalenotomy. In the present study the authors seek to elucidate further the surgical anatomy of this structure. Methods Eighteen cadaveric sides were dissected of the LTN, anatomical relationships were observed, and measurements were obtained between it and surrounding osseous landmarks. The LTN had a mean length of 27 ± 4.5 cm (mean ± standard deviation) and a mean diameter of 3 ± 2.5 mm. The distance from the angle of the mandible to the most proximal portion of the LTN was a mean of 6 ± 1.1 cm. The distance from this proximal portion of the LTN to the carotid tubercle was a mean of 3.3 ± 2 cm. The LTN was located a mean 2.8 cm posterior to the clavicle. In 61% of all sides the C-7 component of the LTN joined the C-5 and C-6 components of the LTN at the level of the second rib posterior to the axillary artery. In one right-sided specimen the C-5 component directly innervated the upper two digitations of the serratus anterior muscle rather than joining the C-6 and C-7 parts of this nerve. The LTN traveled posterior to the axillary vessels and trunks of the brachial plexus in all specimens. It lay between the middle and posterior scalene muscles in 56% of sides. In 11% of sides the C-5 and C-6 components of the LTN traveled through the middle scalene muscle and then combined with the C-7 contribution. In two sides, all contributions to the LTN were situated between the middle scalene muscle and brachial plexus and thus did not travel through any muscle. The C-7 contribution to the LTN was always located anterior to the middle scalene muscle. In all specimens the LTN was found within the axillary sheath superior to the clavicle. Distally, the LTN lay a mean of 15 ± 3.4 cm lateral to the jugular notch and a mean of 22 ± 4.2 cm lateral to the xiphoid process of the sternum. Conclusions The neurosurgeon should have knowledge of the topography of the LTN. The results of the present study will allow the surgeon to better localize this structure superior and inferior to the clavicle and decrease morbidity following invasive procedures.

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