The long thoracic nerve has no cutaneous sensory territory and supplies only the serratus anterior, but this single motor function is clinically critical because serratus anterior paralysis produces the hallmark clinical sign of medial scapular winging. The nerve travels superficially along the lateral chest wall for its entire course, making it susceptible to direct trauma, traction injuries, and viral neuritis.
| Origin | Anterior rami of C5, C6, and C7 |
|---|---|
| Course | Descends behind the brachial plexus and clavicle, crosses the first rib, and runs on the outer surface of the serratus anterior the full length of the chest wall |
| Motor |
|
| Sensory |
|
Long thoracic nerve palsy is diagnosed by asking the patient to push against a wall with the arm extended, which shows medial scapular winging as serratus anterior fails to hold the scapula flat. In this pattern the medial border lifts and the inferior angle moves toward the midline, unlike trapezius winging, where the scapula drops and moves laterally. On the chest wall the nerve runs on serratus anterior close to the lateral thoracic artery, where it is at risk in axillary node dissection, mastectomy, first rib resection and lateral thoracotomy. Most non-surgical palsies recover over 1 to 2 years with scapular stabilisation physiotherapy; persistent cases may be treated by nerve transfer or pectoralis major transfer.
Serratus anterior paralysis from nerve injury producing medial scapular winging most visible during a wall push-up, caused by direct axillary trauma, heavy backpack traction, viral neuritis, or surgical positioning.
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