Chest 1996 Jan;109(1):31-34

Iatrogenic serratus anterior paralysis. Long-term outcome in 26 patients.

Kauppila LI, Vastamaki M

STUDY OBJECTIVE: To evaluate the treatment, extent of recovery, and residual disability in 26 iatrogenic cases of serratus paralysis. PATIENTS AND STUDY DESIGN: Seventeen cases of serratus anterior paralysis had occurred following a local invasive procedure along the course of the long thoracic nerve, including seven first-rib resections, four mastectomies with axillary dissection, two scalenotomies, two surgical treatments of spontaneous pneumothorax, and two infraclavicular plexus anesthesia. Eight cases of paralysis had occurred after general anesthesia for patients who had undergone surgery for diverse clinical reasons. One case of paralysis occurred after spinal anesthesia. The length of sick leave, treatment with a shoulder brace, amount of physical therapy, long-term symptoms, and residual disability were evaluated from the medical records and from the questionnaire sent to the patients on average 6 years (range, 2 to 11 years) after the onset of the paralysis. RESULTS: Despite comprehensive and leng thy treatment, all but one had residual symptoms, as well as limitations in the use of the affected limb. Twenty-one (81%) of the patients could not lift or pull heavy objects, 15 (58%) could not play sports, such as tennis or golf, and 14 (54%) found it impossible to work with hands above shoulder level. CONCLUSION: Serratus anterior paralysis, following anesthesia or local invasive procedures on the anterolateral aspect of the thorax, may cause considerable and long-term dysfunction of the shoulder girdle and affect the function of the whole upper limb.

Br J Sports Med 1993 Jun;27(2):90-91

Scapula winging in a sports injury clinic.

Packer GJ, McLatchie GR, Bowden W

Scapula winging is an uncommon condition but one which may be underdiagnosed. Four patients with scapula winging referred to a sports injury clinic are presented. None of the patients was aware of any trauma and a traction injury to the long thoracic nerve is proposed as the aetiology of this condition. These case reports emphasize the importance of excluding winging of the scapula in patients who present to sports injury clinics with shoulder pain.

J Bone Joint Surg [Br] 1983 Nov;65(5):552-556

Isolated paralysis of the serratus anterior. A report of 20 cases.

Foo CL, Swann M

A description is given of 20 patients with winging of the scapula. The majority had suffered spontaneous severe pain in the region of the shoulder followed about two weeks later by the deformity and associated loss of function. Only in three patients was there a clear history of trauma. Some patients may have strained the arm, but in the majority no single factor heralded the problem. Most of the patients were followed up for more than two years and it became clear that functional recovery could take up to this time to be complete. However, careful examination revealed that often a slight degree of winging remained. No specific treatment apart from gentle physiotherapy was prescribed and certainly no operative procedures. It is considered that a number of these cases were examples of neuralgic amyotrophy.

J Bone Joint Surg [Am] 1979 Sep;61(6A):825-832

Serratus anterior paralysis in the young athlete.

Gregg JR, Labosky D, Harty M, Lotke P, Ecker M, DiStefano V, Das M

Ten cases of isolated, complete paralysis of the serratus anterior muscle were diagnosed in young athletes during a three-year period. One patient had recurrent partial paralysis of the serratus anterior muscle, the first such case reported. From studies on cadavera and clinical observations, we concluded that paralysis of the serratus anterior muscle results from a traction injury to the long thoracic nerve of Bell. Since full recovery usually occurs in an average of nine months, surgical methods of treatment should be reserved for patients in whom function fails to return after a two-year period. Non-strenuous use of the involved extremity with avoidance of the precipitating activity, followed by exercises designed to maintain the range of motion of the shoulder and to increase the strength of associated muscles, is advocated for treatment of acute or repetitive injuries to the long thoracic nerve of Bell.

Phys Ther 1983 Aug;63(8):1243-1247

Incidence, recovery, and management of serratus anterior muscle palsy after axillary node dissection.

Duncan MA, Lotze MT, Gerber LH, Rosenberg SA

The purposes of this study were to determine the occurrence of serratus anterior muscle weakness after axillary node dissection, to monitor the recovery of serratus anterior muscle strength, and to compare shoulder range of motion in palsied and nonpalsied groups. Thirty-six patients were studied who had 40 axillary node dissections for breast carcinoma or malignant melanoma. Range of motion and manual muscle tests were done preoperatively and at specific postoperative intervals by two observers. To regain range of motion, all subjects were treated daily while hospitalized and as needed when outpatients. Twelve of the 40 dissections (30%) resulted in serratus anterior muscle palsy after surgery. Strength was normal in all the palsied shoulders by the sixth month after surgery. Both the palsied and nonpalsied groups had comparable range of motion at each assessment. The mechanism of long thoracic nerve injury and the clinical significance of serratus anterior muscle palsy are discussed as well as the rationa le for early detection and proper physical therapy management. This study suggests that serratus anterior muscle palsy is a frequent but reversible event after axillary node dissection. .

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