Syndrome of fascial incarceration of the long thoracic nerve: winged scapula

Abstract

ObjectiveTo analyze the results from early intervention surgery in patients with the syndrome of fascial incarceration of the long thoracic nerve and consequent winged scapula.MethodsSix patients with a syndrome of nerve trapping without specific nerve strain limitations were followed up.ResultsThe patients achieved improvement of their symptoms 6–20 months after the procedure. The motor symptoms completely disappeared, without any persistent pain. The medial deformity of the winged scapula improved in all cases, without any residual esthetic disorders.ConclusionThe approach of early surgical release seems to be a better predictor for recovery from non-traumatic paralysis of the anterior serratus muscle.

SBP block: further considerations

“…The colleagues have suggested 30 ml as the optimal volume to avoid technique failure; however, a previous study [2] has reported that a volume of 25 ml provides unsatisfactory anesthesia in a short stature patient. For this reason, we believe that further studies with a large population size are needed to have a final say on this topic.We agree with the colleagues that long thoracic nerve, thoracodorsal nerve, and pectoral nerves are primarily motor nerves; however, we have to highlight that damage to these nerves could cause severe pain in the patients; in particular, a lesion to the long thoracic nerve causes a neuropathic pain in the scapular area [3]. A recent study comparing pectoral nerves block (Pecs block) to paravertebral block concluded that surgical patients receiving Pecs block had a significantly prolonged duration of postoperative analgesia with a lesser requirement for rescue analgesia, probably because of a more effective block of the brachial plexus [4].…”

“…We agree with the colleagues that long thoracic nerve, thoracodorsal nerve, and pectoral nerves are primarily motor nerves; however, we have to highlight that damage to these nerves could cause severe pain in the patients; in particular, a lesion to the long thoracic nerve causes a neuropathic pain in the scapular area [3]. A recent study comparing pectoral nerves block (Pecs block) to paravertebral block concluded that surgical patients receiving Pecs block had a significantly prolonged duration of postoperative analgesia with a lesser requirement for rescue analgesia, probably because of a more effective block of the brachial plexus [4].…”

Surgical and Clinical Decision Making in Isolated Long Thoracic Nerve Palsy

“…2,7,16 The optimal surgical treatment, however, would preserve the natural serratus anterior motor function. This can be achieved with long thoracic nerve decompression (in the setting of conduction block) 4,[10][11][12][13][14]20,22 or by nerve transfers that reinnervate the serratus anterior muscle. 15,19,23,24 Nerve transfers allow nearby healthy axons to reinnervate the injured serratus anterior muscle close to the motor endplates and prior to atrophy.…”

“…[10][11][12]15,22,24 Authors describe decompression alone as treatment for isolated long thoracic nerve palsy refractory to conservative management. [10][11][12]22 Le Nail et al reported a retrospective review of 52 distal long thoracic nerve decompressions in a young patient population. 11 The improvement was excellent or good in 87% of patients, and 62% completely corrected their winged scapula.…”

Son ütücü olarak çalışan bir olguda spinal aksesuar sinir hasarına bağlı kanat skapula

“…Kanat skapula (skapula alata) sıklıkla skapulotorasik stabilize edici kaslar olan serratus anterior, trapezius ve rhomboid kasların disfonksiyonuna bağlı gelişen, skapula medial kenarının torakstan uzaklaşması ile karakterize bir klinik durumdur (1,2). Skapulohumeral ritmin bozulmasına bağlı omuz kas gücünde azalma, eklem hareket açıklıklarında azalma, kozmetik problemler, periskapular kaslarda gerginlik ve spazma bağlı ağrıya neden olabilir (3,4 Ağır yük torbası taşıma, travma ve sporla ilişkili yaralanmalara bağlı gelişebileceği gibi sıklıkla servikal lenf doku diseksiyonu ve kitle eksizyonu gibi cerrahiler sırasında iatrojenik olarak görülür (4,5).…”