Summary about Disease
Long Thoracic Nerve Palsy (LTNP) is a condition characterized by weakness or paralysis of the serratus anterior muscle. This muscle is responsible for protracting the scapula (shoulder blade) and rotating it upwards, allowing for overhead arm movements. Damage to the long thoracic nerve, which innervates the serratus anterior, results in winging of the scapula, impaired shoulder function, and potential pain.
Symptoms
Winging of the scapula: The most prominent sign, where the medial border of the scapula protrudes prominently from the back, especially when pushing against a wall or raising the arm.
Shoulder pain: Aching or discomfort in the shoulder and upper back region.
Weakness in arm elevation: Difficulty raising the arm overhead, especially above 90 degrees.
Limited shoulder abduction and flexion: Reduced range of motion in lifting the arm away from the body and forward.
Difficulty with pushing or reaching: Tasks requiring scapular stabilization become challenging.
Causes
Trauma: Direct blow to the shoulder, neck, or chest; repetitive overhead activities; sudden stretching or compression of the nerve.
Surgery: Particularly procedures involving the neck or chest, such as lymph node dissection or mastectomy.
Viral Illness: Some viral infections can cause inflammation and damage to the nerve.
Idiopathic: In some cases, the cause is unknown.
Weight training or strenuous activity
Medicine Used
Pain relievers: Over-the-counter analgesics like ibuprofen or acetaminophen to manage pain. Prescription pain medications may be used in severe cases.
Nerve pain medications: In some cases, medications like gabapentin or pregabalin may be prescribed to help manage nerve pain.
Corticosteroids: Oral or injected corticosteroids may be considered to reduce inflammation around the nerve, especially in acute cases.
Is Communicable
Long Thoracic Nerve Palsy is not communicable. It is not an infectious disease and cannot be spread from person to person.
Precautions
Avoid activities that aggravate the condition: Refrain from repetitive overhead movements, heavy lifting, and activities that cause pain.
Proper posture: Maintain good posture to avoid further strain on the shoulder and neck.
Ergonomic adjustments: Modify work or home environments to reduce stress on the shoulder.
Shoulder and Neck Care: Maintain Good posture. Take breaks, if sitting for long duration.
How long does an outbreak last?
Long Thoracic Nerve Palsy is not an outbreak. It is a condition, but recovery time varies. Some individuals recover spontaneously within several months to a year. Others may require longer treatment and rehabilitation. In severe cases, or when conservative management fails, surgery may be considered, and recovery can take several months post-operatively.
How is it diagnosed?
Physical Examination: Assessment of scapular winging, shoulder range of motion, and muscle strength.
Medical History: Review of past injuries, surgeries, and medical conditions.
Nerve Conduction Studies (NCS) and Electromyography (EMG): These tests assess the function of the long thoracic nerve and the serratus anterior muscle.
Imaging studies: X-rays, MRI, or CT scans may be used to rule out other causes of shoulder pain and dysfunction.
Timeline of Symptoms
Initial injury/event: The onset of symptoms can be sudden (e.g., after trauma) or gradual (e.g., with repetitive activities).
Acute phase: Pain, weakness, and scapular winging are most prominent.
Subacute phase: Pain may decrease, but weakness and scapular winging persist.
Chronic phase: If untreated, weakness and scapular winging can become permanent, leading to long-term functional limitations. Recovery time varies between individuals.
Important Considerations
Early diagnosis and treatment are crucial to improve outcomes and prevent chronic complications.
Physical therapy is a cornerstone of treatment, focusing on strengthening the serratus anterior and other shoulder muscles, improving scapular stability, and restoring range of motion.
Surgery may be considered if conservative management fails to improve symptoms.
Patients should be educated about the condition, proper posture, and activity modifications to prevent further injury.