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Long thoracic palsy
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Long thoracic palsy - May 25, 2005 6:02:00 AM
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chrisinggs
Posts: 1
Joined: May 24, 2005
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I have a patient presenting with post-viral palsy of the long thoracic nerve - i.e scap winging.
Is there any evidence that treatment makes any difference and what should i be aiming at?
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Re: Long thoracic palsy - May 25, 2005 7:13:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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If reinnervation is a concern, then specific serratus training may be counterproductive.
Maintain ROM and strength, esp cuff and periscapulars.
Try this reference for a summary:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15150060&query_hl=2
Here's a quote from this article, numbers after sentences are citations from the reference list, which is valuable as well:
NATURAL HISTORY.
The natural history of atraumatic long thoracic nerve palsy is resolution within 1 year.63 However, cases due to Parsonage-Turner syndrome (brachial plexitis) may take as long as 2 to 3 years to resolve.35 It has been reported that nonoperative treatment will not be successful in approximately one quarter of patients affected by long thoracic nerve injury.(3,4)
TREATMENT.
Because of the relatively good prognosis for spontaneous recovery, the mainstay of initial management is a nonoperative program. Nonoperative treatment for this problem includes relative rest, symptomatic management, reassurance, maintaining shoulder range of motion, strengthening of compensatory muscles, and possibly bracing. With regard to relative rest, the athlete should avoid lifting heavy objects or participating in activities that exacerbate symptoms and place the nerve at risk. Pain should be managed symptomatically by use of non-steroidal anti-inflammatory drugs or other medications for neurogenic pain. Athletes should be reassured and informed of the fact that most cases of atraumatic long thoracic nerve injury subside within 6 to 9 months,35 and almost all cases resolve satisfactorily within 12 months.34,39,52,83,110 It should be stressed to the patient to maintain full glenohumeral range of motion, actively, passively, and actively assisted. Furthermore, strengthening of the scapular stabilizers, particularly the trapezius, rhomboids, and levator scapulae, should be instituted because these are stressed more in the face of a nonfunctioning or dysfunctional serratus anterior.
I wonder what the recovery expectation is of a post-viral injuries vs traumatic injuries? Unsure of that...
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Long thoracic palsy - May 25, 2005 4:14:00 PM
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jma
Posts: 2319
Joined: August 24, 2000
From: NY
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If there are no articles on it in the literature, this could make for a great case study.
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Re: Long thoracic palsy - May 26, 2005 2:20:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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Good point JMA, the literature has plenty of case studies from traumatic cases, but in my admittedly brief search, I did not find one with this etiology.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Long thoracic palsy - May 17, 2006 10:02:00 PM
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Eliana
Posts: 7
Joined: August 27, 2002
From: Pueblo, CO, USA
Status: offline
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Long thoracic nerve injury is very common on axillary dissection done for pts with melanomas or mastectomy. Definitely you should keep shoulder ROM and try exercises with pt on supine position where you can the fix the scapule with the weight upon it.
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