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Neuritis of the Long Thoracic Nerve

Causes: Isolated paralysis of the serratus anterior is caused by a palsy of the long thoracic nerve. The lesion is usually idiopathic, but damage to the nerve caused by a blow, excessive movements or thoracic or cervical surgery has been described.

Clinical presentation: Spontaneous onset of unilateral dull scapular pain lasting a few weeks. The pain is constant and not influenced by posture or movement. The arm becomes tired. Functional examination of the shoulder shows a painless limitation of the active elevation. The passive elevation is of full range and painless. The resisted movements of the shoulder are strong and painless. A winged scapula is visible during active elevation or during an accessory test.

Evolution: The scapular pain eases after a few weeks to disappear completely after a month. There is restoration of motor function after about eight months.

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