Long thoracic nerve

Structure

Origin

The long thoracic nerve arises from the anterior rami of cervical spinal nerves C5, C6, and C7. The root from C7 may occasionally be absent. The roots from C5 and C6 pierce through the scalenus medius, while the C7 root passes in front of the muscle.

Course and relations

The long thoracic nerve descends through the cervicoaxillary canal. It is posterior to the brachial plexus, and the axillary artery and vein. This takes it deep to the clavicle. It rests on the outer surface of the serratus anterior muscle. It extends along the side of the thorax to the lower border of the serratus anterior muscle, supplying fibres to each of the muscle's digitations.

Function

The long thoracic nerve innervates the serratus anterior muscle. It supplies filaments to each of its digitations (finger-like projections).

Clinical significance

Due to its long, relatively superficial course, the long thoracic nerve is susceptible to injury, either through direct trauma or stretch. Mechanisms of injury include:

• nerve lesions.
• various sports injuries, typically occurring from a blow to the ribs underneath an outstretched arm.
• surgery for shoulder and thorax. Treating breast cancer with removal of axillary lymph nodes.
• carrying weight, such as heavy bags, over the shoulder for a prolonged time.
• Parsonage Turner Syndrome, an autoimmune disease.
• trauma or infection.

Symptoms are often minimal – if symptomatic, a posterior shoulder or scapular burning type of pain may be reported. Some injuries, particularly lesions, can paralyse the serratus anterior muscle to produce a winged scapula. This is most prominent when the arm is lifted forward or when the patient pushes the outstretched arm against a wall. However, even winging may not be evident until the trapezius stretches enough to reveal an injury several weeks later.

References

Additional images

File:Gray809.png|The right brachial plexus (infraclavicular portion) in the axillary fossa; viewed from below and in front. File:Brachial plexus.svg|Brachial plexus File:Brachial_plexus_color.svg|Brachial plexus with courses of spinal nerves shown

References

1. Rakocevic, G.. (2014-01-01). "Thoracic Nerve, Long". Academic Press.
2. (2015-01-01). "Chapter 43 - Anatomic Landmarks for Selected Nerves of the Head, Neck, and Upper and Lower Limbs". Academic Press.
3. (2015-01-01). "Chapter 14 – Mononeuropathies". Academic Press.
4. Tomberlin, John. (2009-01-01). "CHAPTER 53 - Neurodynamic Techniques for the Athlete's Shoulder". Churchill Livingstone.
5. Fischer, J. (2012). Anatomy of the Axilla. Fischer's Mastery of Surgery, 2 Volume Set. Retrieved September 20, 2015 from http://www.r2library.com/Resource/Title/1608317404/ch0046s1193
6. (2005). "Long Thoracic Nerve: Anatomy and Functional Assessment". The Journal of Bone and Joint Surgery. American Volume.
7. (2015-01-01). "Chapter 34 - Injuries of the Nerves of the Thorax". Academic Press.
8. (2004). "An Isolated Long Thoracic Nerve Injury in a Navy Airman". Military Medicine.
9. (2015). "Long thoracic nerve injury in breast cancer patients treated with axillary lymph node dissection". Supportive Care in Cancer.
10. (2017-02-01). "Long Thoracic Nerve Injury Caused by Overhead Weight Lifting Leading to Scapular Dyskinesis and Medial Scapular Winging". Journal of Osteopathic Medicine.
11. (2015-04-17). "Parsonage–Turner syndrome". Revista Brasileira de Ortopedia.
12. (June 2014). "Isolated paralysis of the serratus anterior muscle: surgical release of the distal segment of the long thoracic nerve in 52 patients". Orthopaedics & Traumatology, Surgery & Research.
13. (2013-01-01). "31 - Proximal Neuropathies of the Shoulder and Arm". W.B. Saunders.