What Is Long Thoracic Nerve Palsy?

Long pectoral nerve: One of the spinal nerves of the long pectoral nervous system. Emanating from the upper part of the clavicle of the brachial plexus, it descends along the outer side of the anterior serratus muscle and innervates this muscle. This nerve is short and if damaged, the motor and sensory functions of the serratus anterior can be impaired. The long thoracic nerve is the upper branch of the brachial plexus and clavicle, and contains the fibers of the anterior branch of the 5th to 7th cervical nerves. After it is issued, it descends along the surface of the anterior serratus muscle outside the chest wall, and branches are distributed over the anterior serratus muscle.

Chinese name: Long thoracic nerve
Foreign name: long thoracic nerve

Armpit: Out
Appear: "Winged Shoulder" Sign

Thoracic Long Nerve Anatomy:

The long thoracic nerves originate from the 5th to 7th cervical nerves and are emitted when these nerves have just emerged from the intervertebral foramen. Among them, the fibers from the 5th and 6th cervical nerves pass through the medial oblique muscle to form a bundle; the fibers of the 7th cervical nerve (sometimes lacking this fiber) pass through the front of the medial oblique muscle to the anterior oblique The upper part of the horn muscle is integrated with the fibers from the 5th and 6th cervical nerves. This trunk descends through the brachial plexus and the back of the first segment of the axillary artery into the axilla, then descends along the axillary surface of the anterior serratus muscle, and finally divides into many small branches, which are distributed in the muscle teeth of the anterior serratus. The posterior triangle of the long thoracic nerve is often damaged due to excessive pressure on the shoulders or severe blows to the neck, causing paralysis of the serratus anterior and pushing the patient's upper limbs forward to resist resistance. Lateral protrusions become "winged shoulders".

Diseases related to the pectoral long nerve:

Thoracic nerve entrapment syndrome:

[Overview]

Long chest nerve entrapment syndrome is a disease caused by shoulder long chest nerve compression, shoulder pain, weak shoulder abduction, and difficulty raising arms. The pectoral long nerve is the longest pure motor nerve in the human body, originating from the C5, C6, and C7 nerve roots, and it dominates the serratus anterior muscle. Most of the scapular dorsal nerves at the beginning of C5 merge with the origin of the pectoralis longus. The psoriasis passes through the tendonous origin and tendon fibrous ring of the medial oblique muscle. The dorsal nerve is compressed together.

[Needle Knife Applied Anatomy]

1. Cervical Shoulder Spinal-Limb Surface Anatomy:

Muscular sign: Mid-inclination muscle.

2. Neck, Shoulder, Spinal and Limb Static Bowstring Mechanics Unit:

(1) Bow

cervical spine

ribs

(2) String

Intervertebral disc: It consists of fibrocartilage and is connected between the upper and lower vertebrae. There are a total of 6 from below the second cervical vertebra to above the first thoracic vertebra.

Neck Fascia: It can be divided into three parts: cervical fascia, organ fascia, and cervical vascular sheath.

cervical ligament: the ligament, the ligamentum flavum, the interspinous ligament, the intertransverse ligament, the joint capsule ligament, etc.

3. Neck-Shoulder-Spine-Lim Dynamic Bowstring Mechanics Unit:

(1) Bow: Same as static bowstring mechanics unit.

(2) String: The median oblique muscle, starting from the transverse process of the cervical vertebra and ending at the first rib. Function: Raise the first rib to help inhale deeply. If the ribs are fixed, one side contraction can make the neck flex to the same side; both sides contract at the same time, making the neck forward flexion.

[Etiology and Pathology]

There are many factors that can cause thoracic long nerve injury: a variety of sports traction injuries can cause thoracic long nerve injury; repeated heavy loads or heavy manual labor with shoulders can also cause thoracic long nerve injury; axillary area During surgery or first rib resection, it is easy to damage the thoracic long nerve and cause paralysis of the thoracic long nerve; scar response caused by brachial plexus trauma and radiation tissue sclerosis can also cause the occurrence of thoracic nerve compression syndrome. [1]

[Clinical manifestations]

1. Medical history and symptoms:

(1) The patient may have a history of neck discomfort or "cervical spondylosis".

(2) Discomfort in the chest, side of the chest and underarms, with pain, acupuncture-like pain, like angina pectoris on the left chest wall.

(3) If combined with scapular dorsal nerve entrapment, the patient may have radiating pain from the back to the front of the heart.

(4) Cardiac examination excludes angina.

2. Signs:

(1) The tenderness at the midpoint of the posterior margin of the sternocleidomastoid muscle is significant.

(2) Tapping on the chest may induce chest tingling.

(3) There are signs of dorsal scapular nerve entrapment when combined with dorsal scapular nerve entrapment.

(4) Pterygoid scapularis is a typical sign of thoracic nerve injury. Examination method of wing-shaped scapula: When the arm is extended or pushed against the wall, it can induce the occurrence of wing-shaped scapula.

[Diagnosis points]

If the symptoms disappear after the neck pain point is partially closed, the possibility of entrapment of the long chest nerve should be highly considered. Electromyography is helpful in diagnosis.

[Differential diagnosis]

This disease needs to be distinguished from the following diseases.

1. Angina pectoris: The pain in the left chest must be distinguished from angina pectoris, and the heart should be examined.

2. Biliary colic: For the discomfort and pain in the right chest, the possibility of gallbladder and biliary tract disease should be considered, and it is not difficult to rule out the combination of abdominal signs and biliary tract history.

treatment

Needle knife treatment is based on the theory of etiology and pathology of chronic soft tissue injury of needle knife medicine and closed knife surgery theory. Through precise closed needle knife release of nerve compression points, it can completely replace open surgery and cure the disease.

1. Needle-knife treatment:

(1) Posture: prone position.

(2) Body surface positioning: the midpoint of the posterior margin of the medial scalene muscle, the positive point of Tinel.

(3) Anesthesia: 1% lidocaine for local anesthesia.

(4) Knife: Use a type I needle knife.

5) The needle knife is operated near the midpoint of the posterior edge of the medial scalene muscle, and is positioned with a positive point of the Tinel sign. The needle knife body is perpendicular to the skin, the knife edge line is consistent with the longitudinal axis of the upper limb, and the needle knife is inserted according to the four-step procedure. The skin, subcutaneous tissue, and superficial fascia, when there is a sense of emptiness under the knife, that is, the point of compression caused by the long thoracic nerve when wearing the tendon structure of the oblique tendon, slightly lift the needle knife 0.3cm, and sparsely peel 3 Knife, the range is not more than 0.5cm, in order to loosen the oblique tendon structure on the long chest nerve.

2. Manipulative treatment of needle and knife, prone position, do neck extension and lateral flexion 2 to 3 times.

Rehabilitation after needle knife surgery

1. Purpose: The purpose of rehabilitation after needle-knife overall release is to further adjust the force balance of the cervical shoulder-spine spine-limb arch string mechanical system, promote local blood circulation, accelerate local metabolism, and facilitate early repair of damaged tissue.

2.Principle: The following therapies can be used for rehabilitation treatment 48 to 72 hours after needle knife surgery for thoracic long nerve entrapment syndrome.

3. Method:

(1) Traditional Chinese medicine iontophoresis method

(2) Rehabilitation exercise

Adversarial: 15 minutes × 2 groups, 2 times a day × 30 days.

Pressing the chest: 5 minutes × 2 groups, 2 times a day × 30 days.

Waist rubbing: 10 minutes × 2 groups, 2 times a day × 30 days.