Clinical Examination and Electrodiagnostic Testing in a Rare Case of Long Thoracic Nerve Palsy Following Surgeries Related to an Emergency Appendectomy: A Case Report

Abstract

BACKGROUND: Postoperative neuropathy is an infrequent but potentially serious complication of surgery and may result in significant morbidity. While mechanical injury and perioperative factors are commonly implicated, etiology of postoperative neuropathy can be unclear, particularly when the lesion is spatially remote from the surgical site. CASE PRESENTATION: A 27-year-old male Doctor of Physical Therapy student presented to his orthopaedic professor during class describing a 10-week history of significant right shoulder weakness following surgeries related to an emergency appendectomy. Examination revealed unilateral scapular winging and findings consistent with long thoracic nerve (LTN) palsy. Given the unknown etiology, electrodiagnostic (EDX) testing was subsequently performed for diagnostic clarity. OUTCOME AND FOLLOW-UP: Clinical and EDX examinations confirmed an isolated LTN palsy, while ruling out competing neurogenic and orthopaedic etiologies. Seven-month follow-up revealed minimal subjective and objective improvement in shoulder function and continued scapular winging. DISCUSSION: Orthopaedic physical therapy examination, including EDX testing, correctly identified a rare case of LTN palsy following surgeries related to an emergency appendectomy. Findings informed prognosis and guided exercise prescription. JOSPT Cases 2023;3(1):53–58. Epub: 14 December 2022. doi:10.2519/josptcases.2022.11457