Nerve Transfer to Serratus Anterior Muscle Using the Thoracodorsal Nerve for Winged Scapula in C5 and C6 Brachial Plexus Root Avulsions

Uerpairojkit, Chairoj; Leechavengvongs, Somsak; Witoonchart, Kiat; Malungpaishorpe, Kanchai; Raksakulkiat, Rattavuth

doi:10.1016/j.jhsa.2008.08.005

Cited by 56 publications

(55 citation statements)

References 20 publications

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“…This series of 42 patients included patients with dystrophic and nondystrophic scapula winging, including nine with isolated serratus anterior palsy [62]. Nerve transfer with microneurosurgical techniques is a developing area with reports of successful resolution of winging from transfers, including the thoracodorsal nerve to the long thoracic nerve [63]. The lateral branch of the thoracodorsal nerve is both the correct length and number of axons to provide successful transfer to the long thoracic nerve [64].…”

Section: Treatmentmentioning

confidence: 99%

“…Both of these can lead to painful winging wherescapulothoracicfusionhasbeenshowntobeasuccessfulfirst line surgery. Microneurosurgical nerve transfers are also gaining prominence in the management of scapula winging in association with brachial plexus injury [63][64][65]. Painful winging from diffuse traumatic damage to the scapula stabilizing muscles also responds well to scapulothoracic fusion.…”

Section: Rare Causesmentioning

confidence: 99%

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Scapular Winging

et al. 2014

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This review explores the causes of scapula winging, with overview of the relevant anatomy, proposed aetiology and treatment. Particular focus is given to lesions of the long thoracic nerve, which is reported to be the most common aetiological factor. INTRODUCTIONScapular winging is painful and incapacitating [1,2]. The composite movements of the scapula in rotation, abduction and tilting are essential for normal shoulder function and, if this anchored gliding of the scapula (against the posterior chest wall) is lost, then shoulder abduction can be limited to 90• C or less and the ability

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Section: Treatmentmentioning

confidence: 99%

Section: Rare Causesmentioning

confidence: 99%

Scapular Winging

et al. 2014

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“…However, this procedure is not indicated if muscles other than the serratus anterior are compromised. Additionally, nerve transfers have been described for reduction of scapular instability and improvement in ROM for scapular winging (23,24). These procedures have proved quite beneficial, with few complications for scapular winging secondary to isolated nerve injury/dysfunction, and do not require instrumentation.…”

Section: Discussionmentioning

confidence: 99%

Scapular Stabilization in Patients With Spinal Cord Injury

Pahys

Mulcahey

Hutchinson

et al. 2009

The Journal of Spinal Cord Medicine

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Background: Severe scapular instability can be a considerable problem for people with high-level cervical spinal cord injury. Scapular instability reduces the effectiveness of the already weakened shoulder flexors and abductors, thereby limiting hand-to-mouth and hand-to-head activities. The winged scapula may cause inferior pole skin breakdown, as well as neck and shoulder pain. Objective: To report the efficacy of a fusionless scapular stabilization procedure as a means to enhance function in a consecutive group of patients with high-level cervical spinal cord injury. Methods: Four people with spinal cord injury at C4-C5 (2 male, 2 female; mean age 5 17.3 years, range 5 14-20 years) underwent scapular stabilization via scapulothoracic fusion (N 5 2) or by tethering the scapula to the rib cage with Mersilene tape as a fusionless stabilization (N 5 2). One patient died of unrelated causes 18 months after surgery, and the remaining 3 were followed for 26, 39, and 41 months, respectively. Data collection included radiographic analysis, active range of motion measures, and functional assessment. Results: Active shoulder flexion and abduction remained unchanged in 2 patients, but functional scores improved with regard to feeding and grooming capability. All patients reported satisfaction with postoperative appearance, and 3 patients reported considerable reduction in shoulder pain after surgery. Radiographs demonstrated maintenance of stable scapular alignment in all patients at final follow up. Wound breakdown, requiring removal of instrumentation, occurred in 2 patients. Conclusion: Scapular stabilization with or without fusion is a viable option to improve appearance, pain, and upper extremity function in people with high-level tetraplegia and scapular instability.

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“…25 c) Transferencias nerviosas: El nervio toracodorsal, motor puro, es responsable de la inervación del dorsal ancho, se origina del tronco posterior de las raíces c7 y c8, en ocasiones, c6 también participa. 26 Su transferencia al ntl fue descrita por novack y Mackinon, en 2002. 27 Ellos transfirieron la rama medial del nervio toracodorsal al ntl y obtuvieron un buen resultado en un paciente, a los 7 años de seguimiento.…”

Section: Alternativas Quirúrgicasunclassified

Lesiones del nervio torácico largo de Bell. Revisión de conceptos terapéuticos

Valbuena¹

2014

Rev. Asoc. Arg. Ort. y Traumatol

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Re ci bi do el 17-9-2013. Acep ta do lue go de la eva lua ción el 10-2-2014. Co rres pon den cia:Dr. SEBaStián E. ValBuEna valbuena.sebastian@gmail.comRe su men las lesiones del nervio torácico producen parálisis del serrato anterior y originan una deformidad característica (escápula alata), que genera debilidad y alteraciones importantes en la movilidad del hombro. En esta revisión, se analizan conceptos sobre anatomía, etiología, presentación clínica y alternativas terapéuticas.Palabrasclave:Nerviotorácicolargo.Serrato anterior.Plexobraquial.Parálisis. LongthoracicnerveofBell.Reviewof therapeuticmanagementAbstract the long thoracic nerve injuries are manifested by a characteristic deformity called scapula alata, causing weakness, and impaired shoulder mobility. in this review current concepts of the anatomy, etiology, clinical presentation and therapeutic management are analyzed.Key words: Long thoracic nerve. Serratus anterior muscle.Brachialplexus.Palsy. IntroducciónEl nervio torácico largo (ntl), llamado también nervio respirador externo o nervio de charles Bell, inerva solamente al músculo serrato anterior. Este músculo cumple un rol protagónico en la estabilidad de la escápula, y su parálisis produce una deformidad característica, denominada "escápula alata", que genera debilidad y alteraciones importantes en la movilidad del hombro.la afección del ntl es rara. narakas, en su serie personal de aproximadamente 1000 lesiones del plexo braquial, observó solo 11 casos de compromiso solitario del ntl. 1 la mayoría de las comunicaciones sobre la parálisis del ntl se ocupan de observaciones retrospectivas de pocos casos, de nuevas causas etiológicas, o bien describen detalles técnicos quirúrgicos.2 Anatomíaybiomecánica a)Nerviotorácicolargo:Es un nervio motor puro que nace de las raíces nerviosas cervicales c5, c6 y c7. con menos frecuencia, participan en su formación la raíz c4 o c8 y, en el 8% de los casos, c7 no participa. 3 inmediatamente las ramas destinadas de c5 y c6 se unen formando la división alta del ntl corriendo de forma paralela y en íntima relación con el nervio supraescapular. la rama originaria de c7 o división baja del ntl se dirige hacia distal pasando sobre el escaleno medio y por detrás del escaleno anterior. la división alta del ntl pasa a través del escaleno medio. Esta disposición anató-mica lo hace particularmente susceptible a compresiones o a la lesión durante la cirugía del síndrome del opérculo torácico. 4 Para Bertelli y Ghizon, el ntl a nivel supraclavicular discurre paralelo al plexo braquial y no perpendicular, como está descrito clásicamente en la mayoría de los textos de anatomía. 5 las divisiones alta y baja del ntl se unen antes de pasar por debajo de la primera costilla y la clavícula introduciéndose en el paquete pléxico. El nervio desciende oblicuamente de adelante atrás pasando próximo a las bursas subcoracoidea y subescapular.6

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Nerve Transfer to Serratus Anterior Muscle Using the Thoracodorsal Nerve for Winged Scapula in C5 and C6 Brachial Plexus Root Avulsions

Cited by 56 publications

References 20 publications

Scapular Winging

Scapular Winging

Scapular Stabilization in Patients With Spinal Cord Injury

Lesiones del nervio torácico largo de Bell. Revisión de conceptos terapéuticos

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