Variation of surgical anatomy of the thoracic portion of the long thoracic nerve

Decompression of the long thoracic nerve (LTN) is a potentially beneficial procedure for selected patients with LTN palsy. The aim of this work is to describe the surgical anatomy of the thoracic part of the LTN and highlight its variations. A retrospective review of patients undergoing exploration...

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Bibliographic Details
Published in:Clinical anatomy (New York, N.Y.) N.Y.), 2022-05, Vol.35 (4), p.442-446
Main Authors: Ormsby, Neal M., Hawkes, David H., Ng, Chye Yew
Format: Article
Language:English
Subjects:
Adult
Anatomy
Axilla
Decompression
Electromyography
Exploration
hourglass constriction
Humans
Injury analysis
long thoracic nerve
Muscle, Skeletal
Nerves
neuralgic amyotrophy
Paralysis
Patients
Photography
Retrospective Studies
scapular winging
serratus anterior
Thoracic Nerves - anatomy & histology
Thoracic Nerves - surgery
Thoracic Wall
Thorax
Trauma
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Summary:Decompression of the long thoracic nerve (LTN) is a potentially beneficial procedure for selected patients with LTN palsy. The aim of this work is to describe the surgical anatomy of the thoracic part of the LTN and highlight its variations. A retrospective review of patients undergoing exploration of the LTN was performed. Preoperatively, all patients had serratus anterior dysfunction and underwent electromyographic (EMG) assessment. All patients had an initial trial of nonoperative management. The surgical procedures were undertaken by the senior author. The anatomy of the LTN and the associated vasculature was recorded in patient records, and with digital photography. Forty‐five patients underwent LTN exploration. Two patients with iatrogenic injury were excluded, leaving 43 patients for analysis. Mean age was 36 years. Sixty‐seven percent of cases involved the dominant side. Trauma was the commonest cause, followed by neuralgic amyotrophy. Four patients had typical features of serratus anterior dysfunction but with normal EMG studies. Two distinct patterns of LTN anatomy were noted. In 79% of cases, a single major nerve trunk coursing along serratus anterior was observed and classified as a type I LTN. In 21% of cases, two equal major branches of the nerve were identified, which was classified as a type II LTN. Approximately one in five patients may have two major branches of the LTN. This is of clinical relevance to those who undertake any thoracic procedures, as well as those who are considering exploration of the LTN.
ISSN:0897-3806
1098-2353
DOI:10.1002/ca.23796