Long thoracic neuropathy

Background

• Motor nerve which originates from the C5/C6/C7 levels and innervates the serratus anterior
• Due to its long and relatively superficial course along the lateral aspect of the thorax it is more susceptible to injury

Clinical Features

• Deficits are related to the weakness of the serratus anterior and subsequent "winging" of the scapula"

Differential Diagnosis

• Parsonage-Turner syndrome
• Direct trauma or compression
• Overuse injuries

Evaluation

Workup

• To evaluate for winging have the patient press the affected arm against a wall; the inferior tip of the scapula should project from the thorax if positive

Diagnosis

• Clinical diagnosis

Management

• Varies depending on the underlying etiology of neuropathy
  • Neuropathy secondary to Parsonage-Turner syndrome improves over the course of one to three years
  • Overuse injuries should be managed by avoiding the precipitating movement(s) and avoid carrying significant weight over the shoulder

Disposition

• Outpatient follow-up and physical therapy referral