Rehabilitation of long thoracic nerve injury
Though relatively uncommon, long thoracic nerve (LTN) injury can have significant implications for shoulder function and overall upper body mechanics. This nerve, which primarily innervates the serratus anterior muscle, plays a crucial role in scapular stabilisation and protraction. Injury to this nerve often leads to scapular winging and impaired shoulder mobility, which can affect daily activities and sports participation. In this article, we will explore the common causes, assessment, and treatment of LTN injury.
Understanding long thoracic nerve injury
LTN arises from nerve roots of the neck (C5 to C7 or C8), which then passes through neck muscles (scaleni), goes under the clavicle and first two ribs, travels along the chest wall and reaches the serratus anterior muscle on the side of the rib cage. Traction injury to LTN has been seen in athletes of (but not limited to) archery, volleyball, golf, gymnastics, weight lifting, rifle shooting, etc. On the other hand, compression along the course of the LTN is another possible injury mechanism. Clinically, patients may present with a noticeable winging of the scapula, weakness during overhead movements, and potential pain in the neck, shoulder and/or scapular region. Diagnosis through physical assessment and electromyography (EMG) can confirm nerve involvement, guiding the rehabilitation process.
Assessment for long thoracic nerve injury
On physical examination, the doctor or the physiotherapist will look for the following signs and symptoms:
Neck and shoulder movement, which may trigger pain or discomfort;
Weakness in overhead activities;
Scapular winging;
Wasting or atrophy of serratus anterior;
Loss of upper limb power.
Nerve conduction test and electromyography (EMG) help confirm the diagnosis of LTN injury.
Treatment for long thoracic nerve injury
It is reassuring to know that the natural history for most people with LTN injury is within 1 year, i.e. there is a high chance of spontaneous recovery within 1 year. During this phase, your doctor and physiotherapist will guide you through:
Medications to relieve pain and discomfort;
Relative rest to promote healing of the LTN, such as avoidance or modification of specific activities to avoid provoking symptoms;
Maintaining neck and shoulder range of motion;
Maintaining upper body muscle strength unaffected by LTN;
Progressive return of serratus anterior function.
If the LTN injury does not resolve beyond 1 year, you may discuss the option of surgery with the doctor.
Conclusion
Rehabilitation of long thoracic nerve injury is a multifaceted process. By focusing on pain management, relative rest, strengthening and mobility training, doctors and physiotherapists can help patients regain optimal shoulder function and improve their quality of life. Early intervention and adherence to a structured rehabilitation program are key to successful outcomes, allowing patients to return to their desired activities and sports confidently. Those affected by LTN injuries can recover significantly and restore their shoulder function with proper guidance.
Reference:
Safran MR. Nerve Injury About the Shoulder in Athletes, Part 2. Long Thoracic Nerve, Spinal Accessory Nerve, Burners/Stingers, Thoracic Outlet Syndrome. The American Journal of Sports Medicine 32(4):p 1063-1070, 2004. | DOI: 10.1177/0363546504265193