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Long thoracic nerve palsy

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Long thoracic nerve palsy - February 15, 2006 1:12:00 PM   


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Joined: July 18, 2003
From: Oklahoma City, OK USA
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I have a patient with Serratus Anterior weakness due to long thoracic nerve palsy- I was interested in reading the case report- Watson CJ, Schenkman M. Physical therapy management of isolated serratus anterior muscle paralysis. Phys Ther. 1995;75:194-202.-And I was wondering if any of you have it on hand electronically?

Also, if you have any suggestions on exercises that I can give him for strengthening- it would be very helpful.

A little bit of history- 41y/o male with an onset of right shoulder pain- has hx of pos labral tear in shoulder- He started having pain at the end of his day- he is a cop. Pt also states that he was doing push-ups and he felt that his shoulder was tearing.
Evaluation shows winging of the scapula with abduction and flexion. MMT of trap and rhomboids are 5/5. Little to no muscle contraction from the serratus ant. Pt. had an EMG study that was positive for Long thoracic nerve palsy. Pt. has Full ROM of cervical spine, and no hx of neck/cervical pain. -Spurling, -Distraction, -ULTT and he denies any numbness or tingling.
I am currently applying NMES to his serratus ant while he does a scapular stab program.
If anybody has any suggestions- or treatment plans that have worked for them in the past, I would be happy to hear them.
Post #: 1
Re: Long thoracic nerve palsy - February 15, 2006 8:20:00 PM   


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Joined: April 6, 2004
From: Durham, NC
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Check your email for the article. You could also look for the following:

Role of scapular stabilizers in etiology and treatment of impingement syndrome.

Schmitt L, Snyder-Mackler L.

J Orthop Sports Phys Ther. 1999 Jan;29(1):31-8.

If memory serves, this is the article that incorporated a brace to support the scapula and prevent winging in active shoulder exercises.


Charles Sheets PT OCS Dip MDT

(in reply to tishasutton)
Post #: 2
Re: Long thoracic nerve palsy - February 15, 2006 9:52:00 PM   


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Joined: August 1, 2005
From: Columbus, GA
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hey charles, do you mind sending that article my way also? i too am treating a patient with scapular winging and would love more insight. thanks.


Brian Phillips, PT

(in reply to tishasutton)
Post #: 3
Re: Long thoracic nerve palsy - February 16, 2006 12:55:00 AM   
Alex Brenner PT MPT OCS


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Joined: March 1, 2004
From: Kentucky
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The only thing that I could add is that there is a fine line with the serratus strengthening. The long thoracic nerve is probably trying to reinnervate and if you work the muscle to fatigue it is possible that you could effect this negatively. I do not know of any studies that show this; just going off of personal experience working with peripheral nerve injury.

He should have a repeat EMG in 6-12 weeks to assess recovery. If the nerve is reinnervating then the he will demonstrate something called polyphasic potentials when the needle is in the SA. This is a good thing. Good luck!


Alex Brenner, PT, MPT, OCS

(in reply to tishasutton)
Post #: 4
Re: Long thoracic nerve palsy - February 16, 2006 9:35:00 PM   


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Joined: February 16, 2006
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You might also want to check out "Long thoracic nerve injury". Clin Orthop Relat Res. 199 Nov;(368):17-27 by Waiter JM, Flatow EL. And the article "Scapula Winger's Brace: a case series on the management of long thoracic nerve palsy." Archives of Physical Medicine and Rehabilitation. 1998 Oct Vol. 79(10) Pgs 1226-30.

I have a similar case involving a young CNA. My limited lit. search came up with mixed reviews and results. Her responce to therapy after 4 weeks is fair...with pain now down to a 1-4/10 on VAS. Myo strength of serratus anterior is 1-2/5. Agree with previous post, and get a EMG, follow up after several months, see if reinnervating. Lots of luck.

Fred SanFilipo, DC

(in reply to tishasutton)
Post #: 5
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