Long Thoracic Nerve at Shoulder Level

nervus thoracicus longus (pars humeralis)

The long thoracic nerve descends on the lateral chest wall in contact with the serratus anterior, which it supplies throughout its length. At shoulder level it runs adjacent to the lateral thoracic artery on the serratus anterior surface, accessible to injury during axillary dissection and lateral thoracic approaches.

Region: Shoulder

Clinical Relevance

Clinical Notes

Injury to the long thoracic nerve at shoulder level during axillary node dissection, mastectomy, or first rib resection produces medial scapular winging. The nerve at this level is identified by its characteristic course on the serratus anterior surface and its relationship to the lateral thoracic artery. Nerve transfer from intercostal motor nerves to the long thoracic nerve reconstructs serratus function after irreversible injury.

Pathology

Common Injuries & Conditions

Axillary Long Thoracic Nerve Injury

Iatrogenic injury during axillary lymph node dissection or lateral thoracic surgery producing medial scapular winging and loss of arm elevation above 90 degrees from serratus anterior paralysis.