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 |
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Long thoracic nerve palsy is diagnosed by asking the patient to push against a wall with the arm extended, which reveals medial scapular winging as the serratus anterior fails to hold the scapula flat. This winging pattern, where the medial border lifts and the inferior angle moves away from the thorax, differs from trapezius winging, which produces more superior angle movement. The majority of long thoracic nerve palsies from non-surgical causes recover spontaneously over 1 to 2 years with scapular stabilisation physiotherapy and taping.
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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