Pain lasts 2-3 weeks and is recalcitrant to usual treatments. C3,4,5 Phrenic nerve. the slips of *Injury of long thoracic nerve Cause Paralysis of serratus anterior muscle causing winging of the scapula 1. 17-3A).The roots lie within the vertebral canal and consist of a dorsal root (radix dorsalis) with a spinal ganglion . Long thoracic nerve (LTN) is an important nerve originating from cervical nerve roots. • Innervation Route: C5, C6, C7, C8 → long thoracic nerve → serratus anterior branches. Long thoracic nerve. long thoracic nerve (from ventral rami C5-C7) lateral thoracic a. a lesion of long thoracic nerve will cause winging of the scapula (i.e., the medial border of the scapula falls away from the posterior chest wall and looks like an angel's wing) (Latin, serratus = to saw) serratus posterior inferior It courses along the midaxillary line and above the serratus anterior muscle. The long thoracic nerve is also known as the external respiratory nerve of bell or posterior thoracic nerve, It arises from the superior trunk of the brachial plexus after which it descends posterior to the brachial plexus and anterior to the posterior scalene muscle, passes over the 1st rib, descends along the lateral aspect of the thoracic wall at the mid . The root from C7 may occasionally be absent. The long thoracic nerve travels from the top part of the brachial plexus in the neck to deep into the serratus anterior. Origins: External lateral surfaces and superior borders of the first through eighth ribs. Origins: External lateral surfaces and superior borders of the first through eighth ribs. Origin: ribs 3, 4, and 5 Insertion: coracoid process Action: draws scapula anteriorly Innervation: medial and lateral pectoral nerves Origin: ribs 1-9 Insertion: ventral border of scapula Action: draws scapula anteriorly Innervation: long thoracic nerve Trapezius Origin: external occipital protuberance, spinous processes of thoracic vertebrae The plexus is formed by the anterior rami (divisions) of cervical spinal nerves C5, C6, C7 and C8, and the first thoracic spinal nerve, T1. ORIGIN: ribs 1 - 8 INSERTION: ACTION medial border of scapula stabilizes / depresses (Lateral view) INNERVATION: long thoracic nerve: rotates scapula laterally Muscles Stabilizing Pectoral Girdle Subclavius ORIGIN: rib 1 INSERTION: inferior surface of scapula (anterior view)-----ACTION: pectoral girdle Muscles Stabilizing Pectoral Girdle . long thoracic nerve (from ventral rami C5-C7) lateral thoracic a: a lesion of long thoracic nerve will cause winging of the scapula (i.e., the medial border of the scapula falls away from the posterior chest wall and looks like an angel's wing) (Latin, serratus = to saw) serratus posterior inferior N 175 This muscle originates on the first rib and it depresses the clavicle due to its insertion onto the inferior aspect of the clavicle: , This muscle is innervated by the long thoracic nerve and is also known as the "boxer's muscle" or superhero's muscle: , These muscles elevate, adduct & stabilize the scapula, they are often sore after chopping wood: , This muscle is the superficial and . courses distal and laterally deep to clavicle and superficial to first and second rib. The long thoracic nerve is the motor nerve to the serratus anterior muscle, which functions to pull the scapula forward around the thorax, allowing for anteversion of the arm, and to lift the ribs, assisting in respiration. latissimus dorsi. a) medial pectoral nerve C7 C8 b) ulnar nerve C7 C8 T1 c) dorsal scapular nerve C5 C6 d) long thoracic nerve C6 C7 C8 e) musculocutaneous C5 C6 19) Regarding the brachial plexus: a) the roots lie behind scalenus medius muscle Anatomical knowledge regarding the long thoracic nerve (LTN) is important during surgical procedures considering that dysfunction of this nerve results in clinical problems. Testing these nerves is useful in differentiating between root and plexus lesions. nerve: long thoracic action: depresses scapula, supports the trunk and aids in inspiration Note that is muscle can be tagged in two places! Long Thoracic Nerve Palsy. Structures . The long thoracic nerve, which arises from C5 to C7 nerve roots of the brachial plexus. cervical nerves C3 and C4 receive information about pain in this muscle. 11/9/2012 2 Serratus anterior ORIGIN: INNERVATION: ribs 1 - 8 long thoracic nerve INSERTION: medial border of scapula (Lateral view) ACTION: rotates scapula laterally Long thoracic nerve. Serratus Anterior Origin Insertion • Ribs 1 - 9 • Anterior surface of the medial border of the scapula Nerve • Long thoracic nerve C 5 -C 7 Action • Protracts scapula Teres Major Origin Insertion • Inferior angle of the scapula • Lesser tubercle Nerve • Lower subscapular Action • Adduct and internally rotates humerus The long thoracic nerve is a posterior branch from the C5, C6 and C7 roots of the brachial plexus, and supplies the serratus anterior muscle. [1] Lateral thoracic artery , the superior thoracic artery and the thoracodorsal artery. 1 and 2: upper angle; 3 and 4: length of costal surface ; 5-8: inferior angle: ACTION Laterally rotates and protracts scapula: NERVE What is a hiatus hernia? It is usually traumatic in origin. *Long thoracic nerve injuries are rare and can lead to "winging" of the scapula. Anatomical knowledge regarding the long thoracic nerve (LTN) is important during surgical procedures considering that dysfunction of this nerve results in clinical problems. Clavipectoral fascia is a fibrous sheet present deep to the clavicular part of the pectoralis major muscle. Tumors of nerve sheath origin consist of schwannomas, neurofibromas (plexiform and nonplexiform), and malignant peripheral nerve sheath tumors (MPNSTs). The thoracodorsal nerve originates from the posterior cord of the brachial plexus his nerve receives contributions from spinal nerves C6, C7 and Due to its length and the fact that it arises between the superior and inferior subscapular nerves, the thoracodorsal nerve is also known as the middle subscapular or long subscapular nerve.. The long thoracic nerve (LTN) mainly originates from the C5 to C7 nerve roots, occasionally also involving the C4 and C8 roots [1-4].In mostcases, theC5 andC6 rootsunitetoforma superior trunk at the height of the interscalene spatium, before unifying with the C7 root (also called the inferior trunk)[1-4]. Muscles enclosed: Subclavius and pectoralis minor. If the long thoracic nerve is damaged or bruised it can cause paralysis of the serratus anterior muscle and winging of the scapular or shoulder blade. Origin: External surface of lateral part of ribs 1-8 Insertion: Costal aspect of medial margin of scapula Innervation: long thoracic nerve from roots of the brachial plexus C5,C6,C7 Action: Protracts and stabilizes scapula, assists in upward rotation of scapula Also, the serratus anterior inferior is responsible for the anterolateral motion of the scapula, which allows for arm . Carpal tunnel syndrome is primarily defined by pain and sensory symptoms: brachialgia paraesthetica nocturna, or nocturnal ascending pain emanating from the wrist, is typical. thoracic nerve.16 The long thoracic nerve can also be affected by nontraumatic events, including positioning during anes-thesia,17 the sequelae of viral ill-ness,18 inoculations,19 and neuritis affecting the brachial plexus or the long thoracic nerve alone.20,21 Even prolonged bed rest has been reported to trigger dysfunction of the long . Description [edit | edit source]. Six patients had an operation to treat a brachial plexus injury, and the long thoracic nerve was electrically stimulated. The the top, lateral portion of the top eight or nine ribs are the points of origin of the serratus anterior muscle, and the long thoracic nerve is the nerve that innervates this muscle. The dorsal scapular nerve arises from the brachial plexus, usually from the plexus root (anterior/ventral ramus) of the cervical nerve C5.Once the nerve leaves C5 it commonly pierces the middle scalene muscle, and continues deep to levator scapulae and the rhomboids (minor superior to major). • Innervation Route: C5, C6, C7, C8 → long thoracic nerve → serratus anterior branches. The long thoracic nerve diameter was nerve, however, is not consistent with previous findings2,3. An accessory long . Extent: From clavicle (margins of subclavian groove) above to the axillary fascia below. Winging is a condition in which the shoulder blade elevates abnormally off of the torso and creates unnatural movement of the shoulder. Origin: Anterolateral surface of first 8 or 9 ribs just anterior to the mid-axillary line Insertion: Anterior surface of the medial margin of the scapula from the superior angle to the inferior angle Actions: Abducts the scapula Nerve supply: Long thoracic nerve Blood supply: Branches of the axillary artery If you have a suprascapular nerve injury you may notice pain or weakness in your rotator cuff muscles. With invariant origin at C7 in the 20 L. gymnocercus plexuses dissected, the long thoracic nerve followed a horizontal path and stood out from the others in the thoracic portion of the serratus ventralis muscle, supplying it. The long thoracic nerve supplies the lower three slips of serratus, running inferiorly on the surface of the muscle, becoming more adjacent to the vascular pedicle as it descends. Methods: The long thoracic nerve and the serratus anterior muscle were studied in fifteen fresh cadavera. Scapular winging is the landmark manifestation of LTN neuropathy and may develop after an accidental injury during selective cervical nerve root or inter-scalene brachial plexus blocks. Anatomy. The posterior aspect of the serratus is partially covered by the latissimus muscle. Long thoracic nerve (LTN) injury has been reported after radiotherapy, trauma, patient's position, transaxillary breast augmentation, implantation of transvenous leads, anaesthetic nerve block and transaxillary incision. Long thoracic nerve (LTN) injury has been reported after radiotherapy, trauma, patient's position, transaxillary breast augmentation, implantation of transvenous leads, anaesthetic nerve block and transaxillary incision. Parasternal (internal thoracic) lymph nodes: drain upper and lower medial quadrant Posterior intercostal nodes : provide 5% of the lymphatic drainage of the breast Resection of the nodes during mastectomy can result in damage to the nerve, leading to sensory loss to the medial arm and winged scapula . Spinal Nerves. Denervation of the serratus anterior muscle at LTN injury results in loss of scapular stabilization or winged scapula. Motor: Long thoracic, Suprascapular, Anterior interosseous Sensory: Superficial radial, Lateral antebrachial cutaneous, Axillary ("soldier's patch") Pt may not notice paresthesia because of severe intense pain. An anatomic and imaging atlas was created to provide detailed information about the six pairs of thoracic nerves (phrenic nerves, vagus nerves, recurrent laryngeal nerves, sympathetic trunks, costal nerves, long thoracic nerves).

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