An anatomical study of the role of the long thoracic nerve and the related scapular bursae in the pathogenesis of local paralysis of the serratus anterior muscle

Horwitz, M. Thomas; Tocantins, Leandro M.

doi:10.1002/ar.1090710402

Cited by 82 publications

(5 citation statements)

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“…We also found an origin from a common trunk with the LTN (30.4%) in fewer cases than Horwitz and Tocantis [19] (44%). Interestingly, Lee et al .…”

Section: Discussionmentioning

confidence: 52%

“…[18] found that C5 (11.3%) and C7 (7.7%) were not necessarily contributing components. Horwitz and Tocantins [19] and Hovelacque [20] found the C7 component of the LTN absent in 8% and 1.7% of cases, respectively. Although other studies found additional contributions from C4 and C8 to the LTN in a small number of cases, we could not identify them in this study [18,19,23].…”

Section: Discussionmentioning

confidence: 99%

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Variations of the origin of collateral branches emerging from the posterior aspect of the brachial plexus

Ballesteros

Ramírez

2014

J Brachial Plex Peripher Nerve Inj

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BackgroundThe frequency of variation found in the arrangement and distribution of the branches in the brachial plexus, make this anatomical region extremely complicated. The medical concerns involved with these variations include anesthetic blocks, surgical approaches, interpreting tumor or traumatic nervous compressions having unexplained clinical symptoms (sensory loss, pain, wakefulness and paresis), and the possibility of these structures becoming compromised. The clinical importance of these variations is discussed in the light of their differential origins.MethodsThe anatomy of brachial plexus structures from 46 male and 11 female cadaverous specimens were studied. The 40–80 year-old specimens were obtained from the Universidad Industrial de Santander's Medical Faculty's Anatomy Department (dissection laboratory). Parametric measures were used for calculating results.ResultsAlmost half (47.1%) of the evaluated plexuses had collateral variations. Subscapular nerves were the most varied structure, including the presence of a novel accessory nerve. Long thoracic nerve variations were present, as were the absence of C5 or C7 involvement, and late C7 union with C5–C6.ConclusionFurther studies are needed to confirm the existence of these variations in a larger sample of cadaver specimens.

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“…We also found an origin from a common trunk with the LTN (30.4%) in fewer cases than Horwitz and Tocantis [19] (44%). Interestingly, Lee et al .…”

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Variations of the origin of collateral branches emerging from the posterior aspect of the brachial plexus

Ballesteros

Ramírez

2014

J Brachial Plex Peripher Nerve Inj

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“…Horwartz and Tocantins have found that in 8% of the cases, C7 may fail to contribute and some times failure from contributions from C5 have been observed in dissecting laboratories [2,3]. The C5 may contribute separately to the serratus anterior muscle.…”

Section: Case Presentationmentioning

confidence: 99%

Variations in brachial plexus and the relationship of median nerve with the axillary artery: a case report

Singhal

Rao

Ravindranath

2014

J Brachial Plex Peripher Nerve Inj

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BackgroundBrachial Plexus innervates the upper limb. As it is the point of formation of many nerves, variations are common. Knowledge of these is important to anatomists, radiologists, anesthesiologists and surgeons. The presence of anatomical variations of the peripheral nervous system is often used to explain unexpected clinical signs and symptoms.Case PresentationOn routine dissection of an embalmed 57 year old male cadaver, variations were found in the formation of divisions and cords of the Brachial Plexus of the right side. Some previously unreported findings observed were; direct branches to the muscles Pectoralis Minor and Latissimus dorsi from C6, innervation of deltoid by C6 and C7 roots and the origin of lateral pectoral nerve from the posterior division of upper trunk. The median nerve was present lateral to axillary artery. The left side brachial plexus was also inspected and found to have normal anatomy.ConclusionThe probable cause for such variations and their embryological basis is discussed in the paper. It is also concluded that although these variations may not have affected the functioning of upper limb in this individual, knowledge of such variations is essential in evaluation of unexplained sensory and motor loss after trauma and surgical interventions to the upper limb.

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“…However, diverse variations in the cervical nerve roots contribute to LTN. In several studies, LTN was reported to occasionally originate from the C4 or C8 nerve root [ 17 , 19 , 20 ]. In an ultrasound observational study by Lieba-Samal et al, the C7 nerve root contribution was found in only 28% of volunteers [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Analysis of Needle Injury to the Long Thoracic Nerve during Ultrasound-Guided C7 Selective Nerve Root Block

Kang

Jeong

Kim³

et al. 2021

Medicina

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Background and Objectives: Ultrasound (US)-guided cervical selective nerve root block (SNRB) is a widely used treatment for upper limb radicular pain. The long thoracic nerve (LTN) passes through the middle scalene muscle (MSM) at the C7 level. The needle trajectory of US-guided C7 SNRB pierces the MSM, therefore indicating a high probability of injury to the LTN. We aimed to identify the LTN and to investigate the risk of needle injury to the nerve during US-guided C7 SNRB. Materials and Methods: This retrospective observational study included 30 patients who underwent US-guided SNRB at the C7 level in a university hospital. We measured the maximal cross-sectional diameter (MCSD) of the LTN and cross-sectional area (CSA) of the C7 nerve root and assessed the injury risk of LTN during US-guided C7 SNRB by simulating the trajectory of the needle in the ultrasound image. Results: The LTN was detectable in all the cases, located inside and outside the MSM in 19 (63.3%) and 11 (36.7%) of cases, respectively. The LTN’s mean MCSD was 2.10 mm (SD 0.13), and the C7 root’s CSA was 10.78 mm2 (SD 1.05). The LTN location was within the simulated risk zone in 86.7% (26/30) of cases. Conclusion: Our findings suggest a high potential for LTN injury during US-guided C7 SNRB. The clear visualization of LTNs in the US images implies that US guidance may help avoid nerve damage and make the procedure safer. When performing US-guided C7 SNRB, physicians should take into consideration the location of the LTN.

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An anatomical study of the role of the long thoracic nerve and the related scapular bursae in the pathogenesis of local paralysis of the serratus anterior muscle

Cited by 82 publications

References 1 publication

Variations of the origin of collateral branches emerging from the posterior aspect of the brachial plexus

Variations of the origin of collateral branches emerging from the posterior aspect of the brachial plexus

Variations in brachial plexus and the relationship of median nerve with the axillary artery: a case report

Risk Analysis of Needle Injury to the Long Thoracic Nerve during Ultrasound-Guided C7 Selective Nerve Root Block

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