A long thoracic nerve lesion is an injury or dysfunction of the long thoracic nerve, which innervates the serratus anterior muscle. This nerve plays a crucial role in stabilizing the shoulder blade (scapula). Damage to this nerve can lead to winging of the scapula, difficulty with shoulder movements, and impaired function of the upper limb

Causes of Long Thoracic Nerve Lesion

1. Trauma
   • Direct blows to the shoulder or side of the chest.
   • Stretching injuries during activities like lifting heavy objects or sudden movements.
2. Overuse
   • Repeated overhead activities, common in sports like tennis, swimming, or pitching.
3. Surgical Injury
   • Damage during surgical procedures in the chest or axillary region, such as breast surgery, lymph node removal, or thoracic surgeries.
4. Nerve Compression
   • Compression by tumors, hematomas, or inflammation near the nerve’s path.
5. Idiopathic
   • Unknown cause; some cases occur without an identifiable reason, possibly due to viral infections or minor trauma.
6. Neurological Conditions
   • Rarely, diseases affecting peripheral nerves, such as Parsonage-Turner syndrome (neuralgic amyotrophy), may involve the long thoracic nerve.

Symptoms of Long Thoracic Nerve Lesion

• Scapular Winging: The shoulder blade protrudes outward, especially when pushing against a wall.
• Weakness: Difficulty lifting the arm above shoulder level or performing overhead activities.
• Pain or Discomfort: Around the shoulder or side of the chest.
• Functional Impairment: Reduced ability to push, pull, or stabilize the shoulder.
• Muscle Atrophy: Wasting of the serratus anterior muscle in chronic cases.

Diagnosis

1. Physical Examination
   • Observation of scapular winging and testing for shoulder movement impairments.
   • Specific tests like the wall push-up test to provoke winging.
2. Electromyography (EMG) and Nerve Conduction Studies
   • Assess the function of the long thoracic nerve and the serratus anterior muscle.
3. Imaging
   • Ultrasound or MRI may be used to rule out structural causes (e.g., tumors or trauma).
4. Clinical History
   • Assessment of recent trauma, overuse, or surgical history.

Treatment for Long Thoracic Nerve Lesion

Conservative Management

1. Rest and Activity Modification
   • Avoid activities that strain the shoulder, especially repetitive or overhead motions.
2. Physical Therapy
   • Strengthening exercises for the serratus anterior and other shoulder stabilizing muscles (e.g., trapezius, rhomboids).
   • Range-of-motion exercises to prevent stiffness.
   • Scapular stabilization exercises, such as wall push-ups or resistance band exercises.
3. Pain Management
   • Over-the-counter pain relievers like NSAIDs (ibuprofen, naproxen) to reduce pain and inflammation.
4. Bracing
   • Scapular braces can help stabilize the shoulder blade and reduce symptoms during recovery.
5. Observation
   • In mild cases, spontaneous recovery is possible within 6–12 months.

Surgical Treatment

Surgery is considered for severe cases or when conservative treatment fails after 12–18 months:

1. Nerve Grafting or Repair
   • Restores continuity of the long thoracic nerve if it has been severed.
2. Scapular Stabilization Surgery
   • Procedures like pectoralis major transfer to compensate for serratus anterior dysfunction.
3. Decompression Surgery
   • For cases caused by compression of the nerve.

Prognosis

• Recovery depends on the cause and severity of the lesion.
• Minor injuries often improve with conservative management in 6–12 months.
• Severe or prolonged nerve damage may lead to permanent scapular dysfunction without appropriate treatment.

Preventive Measures

• Avoid repetitive overhead activities that can strain the shoulder.
• Warm up and stretch before engaging in sports or strenuous activities.
• Use proper lifting techniques to minimize strain on the shoulder and back.

If symptoms of a long thoracic nerve lesion are present, consult a healthcare provider for an accurate diagnosis and tailored treatment plan. Early intervention can improve outcomes and prevent complications.