Long thoracic nerve

Nerve: 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.)
Latin	nervus thoracicus longus
Gray's	subject #210 933
Innervates	serratus anterior muscle
From	brachial plexus (C5-C7)

The long thoracic nerve (external respiratory nerve of Bell; posterior thoracic nerve) supplies the Serratus anterior. This nerve characteristically arises by three roots from the fifth, sixth, and seventh cervical nerves (C5-C7) but the root from C7 may be absent. The roots from C5 and C6 pierce the Scalenus medius, while the C7 root passes in front of the muscle.

The nerve descends behind the brachial plexus and the axillary vessels, resting on the outer surface of the Serratus anterior. It extends along the side of the thorax to the lower border of that muscle, supplying filaments to each of its digitations (finger-like projections).

Damage

Due to its long, relatively superficial course, it is susceptible to injury either through direct trauma or stretch. Injury has been reported in almost all sports, typically occurring from a blow to the ribs underneath an outstretched arm. Surgically the long thoracic nerve can also be damaged during surgery for breast cancer, specifically radical mastectomies that involve removal of axillary lymph nodes.

Injuries to the nerve can result from carrying heavy bags over the shoulder for a prolonged time. There are also reports of isolated damage to this nerve as a variant of Parsonage Turner Syndrome, an autoimmune disease.

Symptoms are often minimal – if symptomatic, a posterior shoulder or scapular burning type of pain may be reported.

A lesion of the nerve paralyses the serratus anterior to produce winged scapula, which 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.

Additional images

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  The right brachial plexus (infraclavicular portion) in the axillary fossa; viewed from below and in front.

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  Brachial plexus

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  Brachial plexus with courses of spinal nerves shown

External links

• Duke Orthopedics long_thoracic_nerve
• synd/2384 at Who Named It?
• long+thoracic+nerve at eMedicine Dictionary
• SUNY Figs 05:03-07 - "The major subdivisions and terminal nerves of the brachial plexus."