Long thoracic nerve

The long thoracic nerve (external respiratory nerve of Bell; posterior thoracic nerve) supplies the serratus anterior muscle.

Long thoracic nerve
Nerves of the left upper extremity. (Long thoracic labeled vertically at shoulder, to left of artery.)
The right brachial plexus with its short branches, viewed from in front. (Long thoracic labeled at center, third from top.)
Details
Frombrachial plexus (C5-C7)
Innervatesserratus anterior muscle
Identifiers
Latinnervus thoracicus longus
TA98A14.2.03.012
TA26410
FMA65275
Anatomical terms of neuroanatomy

Structure

The long thoracic nerve arises from the anterior rami of the C5, C6, and C7 cervical spinal nerve.[1][2][3] The root from C7 may occasionally be absent.[4] The roots from C5 and C6 pierce through the scalenus medius, while the C7 root passes in front of the muscle.

The long thoracic nerve descends through the cervicoaxillary canal. It is posterior to the brachial plexus,[3] and the axillary artery and vein.[4] This takes it deep to the clavicle.[2] 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.[5][6] It supplies filaments to each of its digitations (finger-like projections).[5][6]

Function

The long thoracic nerve innervates the serratus anterior muscle.[1]

Clinical significance

Due to its long, relatively superficial course, the long thoracic nerve is susceptible to injury, either through direct trauma or stretch.[7] Mechanisms of injury include:

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.[3][8] 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.[9]

See also

References
  1. Rakocevic, G. (January 1, 2014), Aminoff, Michael J.; Daroff, Robert B. (eds.), "Thoracic Nerve, Long", Encyclopedia of the Neurological Sciences (Second Edition), Oxford: Academic Press, pp. 448–450, doi:10.1016/b978-0-12-385157-4.00699-0, ISBN 978-0-12-385158-1, retrieved October 25, 2020
  2. Tubbs, R. Shane; Goodrich, Dylan; Watanabe, Koichi; Loukas, Marios (January 1, 2015), Tubbs, R. Shane; Rizk, Elias; Shoja, Mohammadali M.; Loukas, Marios (eds.), "Chapter 43 - Anatomic Landmarks for Selected Nerves of the Head, Neck, and Upper and Lower Limbs", Nerves and Nerve Injuries, San Diego: Academic Press, pp. 575–588, doi:10.1016/b978-0-12-410390-0.00045-7, ISBN 978-0-12-410390-0, retrieved October 25, 2020
  3. Ryan, Monique M.; Jones, H. Royden (January 1, 2015), Darras, Basil T.; Jones, H. Royden; Ryan, Monique M.; De Vivo, Darryl C. (eds.), "Chapter 14 - Mononeuropathies", Neuromuscular Disorders of Infancy, Childhood, and Adolescence (Second Edition), San Diego: Academic Press, pp. 243–273, doi:10.1016/b978-0-12-417044-5.00014-7, ISBN 978-0-12-417044-5, retrieved October 25, 2020
  4. Tomberlin, John (January 1, 2009), Wilk, Kevin E.; Reinold, Michael M.; Andrews, James R. (eds.), "CHAPTER 53 - Neurodynamic Techniques for the Athlete's Shoulder", The Athlete's Shoulder (Second Edition), Philadelphia: Churchill Livingstone, pp. 707–717, doi:10.1016/b978-044306701-3.50056-6, ISBN 978-0-443-06701-3, retrieved October 25, 2020
  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. Bertelli, Jayme Augusto (2005). "Long Thoracic Nerve: Anatomy and Functional Assessment". The Journal of Bone and Joint Surgery. American Volume. 87 (5): 993–8. doi:10.2106/JBJS.D.02383. ISSN 0021-9355. PMID 15866961.
  7. Ostrowska, Monika; de Carvalho, Mamede (January 1, 2015), Tubbs, R. Shane; Rizk, Elias; Shoja, Mohammadali M.; Loukas, Marios (eds.), "Chapter 34 - Injuries of the Nerves of the Thorax", Nerves and Nerve Injuries, San Diego: Academic Press, pp. 525–543, doi:10.1016/b978-0-12-802653-3.00083-x, ISBN 978-0-12-802653-3, retrieved October 25, 2020
  8. Le Nail, L. R.; Bacle, G.; Marteau, E.; Corcia, P.; Favard, L.; Laulan, J. (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: OTSR. 100 (4 Suppl): S243–248. doi:10.1016/j.otsr.2014.03.004. ISSN 1877-0568. PMID 24703793.
  9. Preston, David C.; Shapiro, Barbara E. (January 1, 2013), Preston, David C.; Shapiro, Barbara E. (eds.), "31 - Proximal Neuropathies of the Shoulder and Arm", Electromyography and Neuromuscular Disorders (Third Edition), London: W.B. Saunders, pp. 487–500, doi:10.1016/b978-1-4557-2672-1.00031-3, ISBN 978-1-4557-2672-1, retrieved October 25, 2020

Additional images
  • The right brachial plexus (infraclavicular portion) in the axillary fossa; viewed from below and in front.
  • Brachial plexus
  • Brachial plexus with courses of spinal nerves shown


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