Winging scapula and Long Thoracic Nerve

[lewynn]

I am a student Physical Therapist Assistant and I am trying to get some information on winging scapula. Most everything I have found states that it is related to a long thoracic nerve problem. I am interested in the physical therapy aspect and recovery treatments available.



What are the most common types of exercises? What is the best exercise for the Serratus Anterior muscle? How do you know for sure if the long thoracic nerve is involved?  



Some of the research I've read says that MRI's or EMG's may not be reliable for detecting mild long thoracic nerve problems that can still cause weakness or malfunction in the Serratus Anterior.



Any help would be greatly appreciated.  Thank you very much for your time with this.



Les Wynn, SPTA

[CCF-Neuro-M.D.-PW]

Winging of the scapula has THREE causes, each with different nerves and different clinical signs



one is caused by the long thoracic nerve and paralysis of serratus anterior - upward and outward movement of the scapula is caused by activation of SA ie pushing against a wall



the second is caused by a lesion to the spinal accessory nerve and trapezius muscle paralysis, this results in winging on elevation of the arm



the third is caused by a dorsal scapular nerve lesion, resulting in rhomboid weakness, and winging on external rotation of the arm



The direction of movement of the scapula during winging is also somehwat characteristic. A good neuromuscular textbook should give you more information



Nerve conduction studies are unreliable and difficult on proximal nerves in the arm. EMG is again difficult to perform in these muscles, although if the lesion is in the brachial plexus for instance other abnormalities (clinical or electrical) may be present. The diagnosis is a clinical one.



I cannot comment on the best physical therapy for the serratus anterior - I will defer to a physical therapist for the best answer

[rizkkhodair]

although the diagnosis of long thoracic nerve is very easy,but you cannot do anything for the patient,i think that this is due to the delay arrive of the patient

[lewynn]

Thank you very much for the comments.  I really appreciate it.



Les

[siva450]

A related discussion, winging of scapula was started.