winged scapula , Long Thoracic Nerve - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes the anatomy of the long thoracic nerve in a very easy and simple animation.
The long thoracic nerve travels in a distal direction behind the brachial plexus between the anterior and middle scalene muscles. It also passes under the clavicle and over the first rib. The nerve runs along the midaxillary line for 22-24 cm to reach the serratus anterior muscle. Due to the fact that it is a longer nerve, it is susceptible to traction related injury. Injury may occur due to axilla dissection or by aggressive retraction of the middle scalene muscle. If the nerve is injured, there will be weakness or paralysis of the serratus anterior muscle which causes medial winging of the scapula.
What is the function of the serratus anterior muscle? The serratus anterior pulls the scapula away from the midline and forward (scapular abduction). It also rotates the scapula upwards. The most important function of the serratus anterior is that it helps to stabilize the scapula so that the other muscles attached to the scapula can work properly.
Serratus anterior palsy: there will be a prominence of the scapular inferomedial edge with medial displacement and downward rotation. The position of the resting scapula is upwards and medial because the trapezius muscle dominates the motion of the scapula.
How do you diagnosis an injury to the nerve? The patient will complain of dull shoulder aches, pain and weakness in association with scapular winging. Injury to the long thoracic nerve (medial winging of the scapula) is checked by having the patient perform the wall push-up test for serratus anterior muscle weakness.
Important points:
•Usually winging of the scapula will cause dull pain due to fatigue of the serratus anterior muscle.
•If there is severe acute pain in addition to winging of the scapula, this is a sign of brachial neuritis that needs to be excluded.
•EMG and nerve studies are very helpful in diagnosing problems of the long thoracic nerve.
•Treatment is usually nonsurgical (observation for at least 6 months)
o Muscle strengthening and bracing
o May take up to a year or longer for recovery
•Surgical treatment (with failure of nonsurgical methods)
o Can be helpful when there is a space occupying lesion pushing on the nerve (decompression of the long thoracic nerve)
o Split pectoralis major transfer for serratus anterior palsy (sternal head of the pectoralis major muscle may be transferred to the inferior border of the scapula).
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[@darrenolson556]

That's about the most helpful video I've ever seen!

[@muhammadshariq8474]

Best anatomy vids on UA-cam with excellent explanations.

[@lomw527]

Thank you very much for your detailed illustration of this complicated concept!

[@aliardogan3763]

thank you for this video.

[@narrycovarrubias375]

Thank you very much Dr. Ebraheim for this informative video.

[@6aviotero]

Thanks for the upload

[@dmurphy8264]

Excellent! Thank you.

[@cberigan1]

Great video. Very thorough. Keep it up doc.

[@dermavideos4789]

Amazing explanation. Thank you so much!

[@samirablackwell8942]

Thanks Nabil! Very helpful

[@larrydavid3520]

great video

[@petersergel9904]

Thank you for that explanation professor ; I'll now be patient !👌

[@6lackwatermagic707]

Lol

[@hosamelsayedorthotube7940]

Thanks for nice helpful video

[@sanatm2874]

The best video nd good explanation...👌

[@greggatchell9255]

Thanks

[@gamaltaher9714]

Good, thanks

[@santasreebhattacharya1271]

For such problems , does one consultant a spine specialist or a normal orthopaedic surgeon ?

[@rahulrl7477]

I am suffering from last 2 years...but I don't know about scapula winging....then I saw ur video..then I understand about winging scapula

[@HafizahHoshni]

Thank you for well explained video! I appreciate it. 27/11/2018 😊

[@tajwarhussain2698]

Stay blessed

[@jannatkhan2595]

Thanku ☺

[@007studios8]

Awesome video. I have had this for over 6 years now. Has anyone had luck or know anyone who has overcame this by surgery?

[@richardturner9755]

What sort of professional would diagnose this? I'm in nz. Have been to see chiropractors before but they never mentioned I had winged scapula. Thanks for any help

[@elijahrobinson2362]

Excellent and informative video. One question I have is for the brachial neuritis...that it must be excluded. What do you mean by excluding it in that context?

[@ashleighthompson3987]

Means that perhaps the problem is brachial neuritis and not a problem with long thoracic nerve. So you must confirm first about the brachial nueritis that it can be excluded as the problem and you can treat the long thoracic nerve issue

[@momoe1974]

I was thinking the same thing

[@michaelstapleton9312]

One thing I would ask that you add is the possibility that this is caused by Hereditary Neuropathy with liability to pressure palsies.
A deletion the PMP22 gene.

[@darrenolson556]

I feel the injury and the wall test proves it however winging is not observable. 2 years with this injury and pain is worsening...dull and deep. Thanks for the stretch though.

[@OfficialEj1]

Dealing with this for 8 months, just flare up the last few days… how you been feeling? Have you done anything that can help this injury?

[@rajvo7406]

How common is recovery

[@drtekchandsharma]

Look at 3:45 ..he is saying medial tilt of inefiror angle but it seems to lateral of infeiror angle

[@ericmckelvey1264]

Thank you!
I've also seen people use electrode placement.
Scapular retraction electrode placement for scapular retraction: The negative electrode is placed under the scapula as far as possible. The positive electrode is placed on the lower portion of the serratus anterior. during the stimulation, the scapula will retract against the thorax wall.
Have you or anyone else used this method?

[@adilserhani1626]

Hi man i have this problem can u helf iny advice 🙏🏻🙏🏻🙏🏻🙏🏻🙏🏻🙏🏻🙏🏻🙏🏻

[@M944]

عندي نفس المشكلة صار سنتين أعاني منها وللاسف مالقيت دكتور أستفيد عندو
نفس المرض

[@adilserhani1626]

اتمنى تكوني بخير
هل وجدتي الحل

[@harshavardhanhegde8709]

I've this problem of scapular winging ... my doc said there is no particular treatment available for this....he sent me to a physician nd adviced some excercises....so will it cure by itself if I continue those excercises?? M having this problem since 2yrs....some1 pls ans

[@powerhouse1981]

Yes do all the exercises. Also stretch and strengthen the neck.

[@laurastovall2713]

So how are you?

[@MrGoodeats]

how’s it going?

[@harshavardhanhegde8709]

It got almost cured...but it is takes long time in years...i got injured in 2016. Now m almost ok after 6years

[@user-xo6ew6um9z]

@@harshavardhanhegde8709 what kind of exercise you used to do?? please tell me....I have been suffring this.

[@farrouh3054]

عندي هذا المشكل هل من مختص اتواصل معه؟؟

[@SamFisher987]

luce luxe هل عولجت منها أخي

[@lahraichymohamed4933]

Hta 3nadi nafs lmochkil 3dakom lik3raf chi wahd

[@rahebothprayerhousedarimad1874]

How many days to fixed

[@nikhilr2761]

Never