top of page

Research Odyssey on the Long Thoracic Nerve

Research Odyssey on the Long Thoracic Nerve
Top 10 Research Quests from Research Raconteur

Are you ready to clinically conquer?

  • FREE Top 10 Research Quests ebook (as voted for by over 5,000 clinicians)

  • FREE infographical summaries on the latest
    clinical research

  • FREE membership to all future Research Quests

As physiotherapists, we often come across patients complaining of shoulder pain and weakness. One of the causes of such symptoms could be injury or dysfunction of the Long Thoracic Nerve. In this blog post, we will discuss the Long Thoracic Nerve in detail, including its anatomy, function, injury, examination, and treatment.



Description of the Long Thoracic Nerve:


The Long Thoracic Nerve (LTN) is a motor nerve that originates from the anterior rami of the C5, C6, and C7 nerve roots. It runs downwards along the posterior aspect of the brachial plexus, between the scalenus medius and anterior muscles, and finally enters the serratus anterior muscle.


The LTN provides motor innervation to the serratus anterior muscle, which plays an essential role in the movement and stability of the scapula. The serratus anterior muscle is responsible for protracting and rotating the scapula during shoulder abduction, thus helping to maintain the shoulder joint's stability.



Function of the Long Thoracic Nerve:


As mentioned earlier, the LTN provides motor innervation to the serratus anterior muscle. The serratus anterior muscle plays an essential role in the movement and stability of the scapula, which is necessary for proper shoulder function. The serratus anterior muscle helps to protract and rotate the scapula, which helps to maintain the stability of the shoulder joint during shoulder abduction. In addition, the serratus anterior muscle helps to upwardly rotate the scapula during arm elevation, which is essential for proper overhead function of the shoulder joint.



Branches of the Long Thoracic Nerve:


The Long Thoracic Nerve is a single nerve that does not give off any branches. However, the nerve fibers of the LTN may branch off and combine with other nerve fibers, forming a network of nerves known as the Thoracodorsal Nerve.



Injury of the Long Thoracic Nerve:


The most common cause of LTN injury is trauma, such as a direct blow to the neck or shoulder region, which may result in traction or compression of the nerve. Other causes of LTN injury include repetitive overhead activities, such as throwing, weightlifting, and swimming, which may cause overuse injuries.


Symptoms of LTN injury include shoulder pain, weakness, and scapular winging. Scapular winging occurs when the scapula protrudes away from the back, giving it a "wing-like" appearance. This occurs due to weakness or paralysis of the serratus anterior muscle, resulting from LTN injury.



Examination of the Long Thoracic Nerve:


Examination of the Long Thoracic Nerve includes a thorough evaluation of the patient's medical history and physical examination. During the physical examination, the therapist may check for scapular winging, which is a hallmark sign of LTN injury.


To assess the strength of the serratus anterior muscle, the therapist may ask the patient to perform a "push-up plus" maneuver. During this maneuver, the patient is asked to push their hands against a wall or other surface while protracting the scapula. This test evaluates the ability of the serratus anterior muscle to protract the scapula and maintain the stability of the shoulder joint.


In addition to the push-up plus maneuver, the therapist may also perform a manual muscle test to assess the strength of the serratus anterior muscle. If the manual muscle test indicates weakness of the serratus anterior muscle, strengthening exercises should be incorporated into the patient's rehabilitation program. These exercises may include wall slides, push-ups with a plus, and scapular punches. The goal of these exercises is to improve the patient's scapular stability and muscular endurance.


If conservative treatment does not result in significant improvement, surgical intervention may be considered. In severe cases of long thoracic nerve injury, nerve grafts or transfers may be necessary to restore function to the serratus anterior muscle.



Treatment of Long Thoracic Nerve injuries


The treatment of long thoracic nerve injury varies depending on the severity of the injury. Conservative management is often the first line of treatment and includes rest, ice, compression, and elevation (RICE), and nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation.


The patient may also be prescribed physical therapy to help reduce pain and inflammation, restore normal range of motion and strength, and prevent the development of any compensatory movements that may arise due to the injury. The physiotherapist may also use modalities such as ultrasound and electrical stimulation to help reduce inflammation and pain and promote healing.


Surgical intervention may be required in cases of severe long thoracic nerve injury, especially if conservative management does not provide relief or if there is evidence of muscle atrophy. Surgery may involve nerve grafting or neurotization, which involves transferring a functioning nerve to the damaged area to restore function.


The decision to proceed with surgery depends on the patient's age, overall health, and the degree of nerve damage.



Main point


The long thoracic nerve is an important nerve that is responsible for the innervation of the serratus anterior muscle. Injury to this nerve can result in significant weakness and dysfunction of the serratus anterior muscle, which can negatively impact the patient's ability to perform activities of daily living.


As such, it is important for physiotherapists to be aware of the anatomy, function, and potential injuries associated with the long thoracic nerve. A thorough examination and treatment plan can help patients recover from long thoracic nerve injuries and return to their normal activities.

References

Coming soon

Kyle (1).png

Written by Kyle van Heerden

Online Educator at Research Raconteur

Top 10 Research Quests from Research Raconteur

Are you ready to clinically conquer?

  • FREE Top 10 Research Quests ebook (as voted for by over 5,000 clinicians)

  • FREE infographical summaries on the latest
    clinical research

  • FREE membership to all future Research Quests

You're in world-class company:

Over 5 000 clinicians from 40 countries trust us

to bring them the latest studies in clinical injury assessment and rehabilitation.

"These updates help me keep up to date on physiotherapy

evidence-based interventions without needing to search for it in databases.


It really does save time, effort and energy.

My favourite thing is that it is very convenient to learn and read with breakdowns of the information into attractive bite size pieces, making it easy for the reader to digest."

- Candace Goh

"The clinical updates have been a great way to stay up-to-date

on some of the research I may have missed, and also have out some of the grunt work taken out of looking for the research myself while still staying on top of the evidence.

My favorite part of the weekly updates is how easy they are to read!"

- Samantha Greig

"These updates save me a lot of time

and I inform my patients of the updates and what the latest research tells us.

The summary of the articles give me

the most important data in a short but potent way.

Saving me time."

- Denise Gous

"The updates help a lot

in that I'm able to recap on the literature we learned in varsity and it goes more in depth which always helps and it gets me in the groove to read more articles.

My favourite thing about the weekly research updates is how recent the articles are and the humour in the email."

- Bheki Motau

"As a full-time clinician,

there are times when you encounter a rush of patients which reduces the amount of time and effort you may provide to reading research.

This is where these research updates become most useful.

Short and crisp with highlighted findings make the job easier and more effective."

- Payal Adwani

"Just a quick thank you for these emails. Trying to treat patients, get admin done and stay on top of research is such a challenge. 

But these emails make things just a little easier!!"

- Meg Steyn

"The updates have helped stay up to date with research

and there is the added bonus that I am don’t have to sift through all the other articles to find it.

My favourite thing is that

the research is clinically relevant

and easy to understand (even the small bits of information before being given the full article.)"

- Keegan Willemse

"Getting synopses of research weekly enables me to

quickly learn about things that are relevant in the setting where I work

without spending hours researching and analyzing

papers for quality of research to see if something might apply where I work."

- Alyson Hackett

"I have found these updates helpful.

I find the content has a nice variability and covers conditions often seen in an out patient private practice

and therefore very relevant."

- Candace Goh

"Your weekly research update is facilitating me to

change my practices

despite of conventional practice.

I also discuss them with my colleagues in my workplace."

- Rasiah Rakunaraj

"Reading the research and getting better ideas of how we can get the best results for our patients is always welcomed.

 

Nice summarised version which is relatively quick to look through.

Your twist on presenting the research is always fun.

Not too much information all at once and hence the information is digestible and can be worked on. "

- Dr Ron van As

"I am glad to say your updates helped me a lot.

 

Our profession is changing at a very fast pace, sometimes I struggle as a full time clinician to find time to look for new information, sometimes I find the amount of info is overwhelming and confusing.

Your updates save me time and energy, they're very short and on point.

Thank you so much for your effort, I really appreciate it."

- Dr. Eiman Alkhezi

"The Updates have helped me

to be acquainted with information that

guides my practice as a clinician.

My favourite thing about the weekly Research Updates is that it is usually succinct."

- Akinwande Oluwadamilare

"Ensuring I get a summary of the latest papers and then

I can go deeper

into them if I find them relevant for me."

- Bryce Jackson

"I find these updates so helpful.

 

It is often so difficult to find time to read articles when you have your own practice.

Between seeing patients and running your practice it becomes difficult to make sure that you are up to date on the latest rehab techniques and new studies that's been done.

 

I used to spend hours

trying to find relevant articles that actually helps me to treat my patients better.

 

These updates makes it so easy and the best part is

you can apply what you read in your practice.

 

I really feel that it makes a huge difference in my practice and if i need to read the whole article it is right at my finger tips.

 

My favorite thing about these weekly updates is that

I learn something new every week

and then I apply that to my rehab.

I love the fact that I can tell a patient I read this article about their injury and this is the latest an greatest new research about it.

They love it as well.

 

It is like breath of fresh air in my practice."

- Drienie Loock

 
bottom of page