The document discusses the applied anatomy of nerve injuries in the upper limb, specifically focusing on the long thoracic nerve. It highlights the anatomical factors predisposing to nerve injuries, the resulting symptoms such as paralysis of the serratus anterior and winging of the scapula, as well as the clinical examination and surgical anatomy related to treating these injuries. References for further reading and educational resources are also provided.

1. Dr.AkramJaffar
Applied Anatomy of Nerve Injuries in the Upper LimbApplied Anatomy of Nerve Injuries in the Upper Limb
Long thoracic nerveLong thoracic nerve
Akram Jaffar, Ph.D.
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2. Dr.AkramJaffar
References and suggested reading
• Ellis H (2006): Clinical anatomy, A revision and applied anatomy for clinical students.
11th
Ed. Blackwell Publishing. Massachusetts
• Moore KL & Dalley AF (2006): Clinically oriented anatomy. 5th
ed. Lippincott Williams
& Wilkins. Baltimore
• Brust JCM (2007): Current Diagnosis & Treatment in Neurology. 2nd
ed. McGraw-Hill
Professional.

3. Dr.AkramJaffar
Objectives
After completion of this session, students should be able to discuss, identify, and describe:
– The anatomical factors predisposing to nerve injuries.
– The anatomy of deformity, weakness and sensory loss following the nerve injury.
– The applied anatomy of clinical examination for specific nerves.
– Surgical anatomy of treating nerve injuries.

4. Dr.AkramJaffar
Long thoracic nerve
Long thoracic n.
C5
C6
C7
• A branch of brachial plexus C5,6, & 7.
• Seen in the pectoral region on the surface of
serratus anterior just behind the mid axillary
line, supplying the muscle.

5. Dr.AkramJaffar
Long thoracic nerve injury
• During radical mastectomy
• Stab wound
• Thoracic surgery
• Chest tube insertion.
• Crushed between clavicle and the first rib
while carrying a heavy object on the
shoulder.
Radical mastectomy bed
Chest tube

6. Dr.AkramJaffar
Long thoracic nerve injury
• Paralysis of serratus anterior.
• Winging of the scapula: medial border of the
scapula projects backwards when the
patient presses against a wall, giving the
appearance of a wing
• Inability to raise the arm above the head:
inability to rotate the scapula during
abduction of the arm above a right angle. 3
trapezius
2
deltoid
1
supraspinatus
3
trapezius
3
serratus anterior
Mechanism of shoulder abduction

7. Dr.AkramJaffar
Long thoracic nerve injury
• Paralysis of serratus anterior.
• Winging of the scapula: medial border of the
scapula projects backwards when the
patient presses against a wall, giving the
appearance of a wing
• Inability to raise the arm above the head:
inability to rotate the scapula during
abduction of the arm above a right angle. 3
trapezius
2
deltoid
1
supraspinatus
3
trapezius
3
serratus anterior
Mechanism of shoulder abduction