Surgical and Clinical Decision Making in Isolated Long Thoracic Nerve Palsy

Abstract

A treatment algorithm based on intraoperative nerve stimulation will help guide surgeons in their clinical decision making in patients with isolated long thoracic nerve palsy. Intraoperative nerve stimulation is the gold standard in the management of isolated long thoracic nerve palsy.

Iatrogenic long thoracic nerve injury and scapular winging in posterior spinal fusion surgery: A case report

“…Patient positioning and placement of surgical retractors are noted as the most probable causes of LTN injury in PSF 3 . Although the deficit was resolved spontaneously in our case, surgical intervention is required for patients who do not respond to conservative treatment 7 8 .…”

“… 3 Although the deficit was resolved spontaneously in our case, surgical intervention is required for patients who do not respond to conservative treatment. 7 The legal aspect of this complication should also be kept in mind because the patient might sue for the damage. 8 For these reasons, a meticulous patient positioning without head flexion, rotation, tilting, and arm overextension, besides careful placement of the surgical retractors, are recommended to avoid LTN injury and its subsequent potential complications.…”

Serratus anterior palsy as a Masquerader: utilizing novel digital dynamic radiography for diagnosis and treatment response

“… 33 DDR can be implemented into clinical workflow to diagnose scapular pathologies, such as SA palsy, by objectively measuring parameters such as SHR to improve diagnosis and treatment of scapular winging. 14 , 23 …”

“… 12 , 17 , 21 , 22 , 29 However, these are often difficult to perform and ability to partake in examination can be limited by impingement pain or instability from a lack of normal SHR. 23 , 30 Magnetic resonance imaging and standard radiographs may be normal as these are static investigations of a dynamic process. Electromyogram (EMG) testing aids in the diagnosis, but testing the SA is technically difficult and technique dependent, and clinicians hesitate to rely solely on EMG findings for indicating surgery.…”

Neurolysis of the Long Thoracic Nerve for Scapular Winging due to Isolated Serratus Anterior Palsy: Early and Midterm Results in 29 Patients

“…In cases where the nerve is in continuity, decompression alone has been shown to be sufficient in resolving scapular winging, [6][7][8][9][10] and the necessity of nerve transfer surgery remains unclear. 11 The existing studies reporting the surgical outcomes of LTN decompression consist of mixed descriptions of the surgical approach to the nerve, heterogeneous methodology regarding the appropriate timing for surgery, and poorly defined outcome assessments of postoperative winging. This makes critical appraisal of the surgical treatment of this condition challenging for clinicians.…”