The long thoracic nerve (nerve to serratus anterior) has an exceptionally long and superficial course on the lateral chest wall making it the most exposed peripheral nerve of the shoulder girdle and the one most commonly injured by traction, viral neuritis, or direct trauma. Its entire course on the superficial surface of the serratus anterior muscle means that surgical retractors, heavy backpacks, or direct blows can all stretch or compress it without any protective tissue barrier.
| Origin | Anterior rami of C5, C6, C7 |
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Long thoracic nerve palsy is the most important cause of medial scapular winging, producing the classic sign of a prominent medial scapular border with inferior angle protrusion during a wall push-up. EMG confirms the diagnosis by showing denervation specifically in the serratus anterior without involvement of other muscles. Most traumatic and viral cases recover spontaneously within 12 to 18 months with physiotherapy for scapular stabilisation and taping.
Serratus anterior paralysis producing medial scapular winging from direct trauma, viral neuritis, or surgical injury, with most cases recovering spontaneously over 12 to 18 months with physiotherapy support.
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