“Isolated long thoracic nerve palsy”: More than meets the eye

Andrés A. Maldonado, Scott L. Zuckerman, B. Matthew Howe, Michelle M Mauermann, Robert J. Spinner

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction Two main hypotheses have been proposed for the pathophysiology of long thoracic nerve (LTN) palsy: nerve compression and nerve inflammation. We hypothesized that critical reinterpretation of electrodiagnostic (EDX) studies and MRIs of patients with a diagnosis of non-traumatic isolated LTN palsy could provide insight into the pathophysiology and, potentially, the treatment. Material and methods A retrospective review was performed of all patients with a diagnosis of non-traumatic isolated LTN palsy and an EDX and brachial plexus or shoulder MRI studies performed at our institution. The original EDX studies and MR examinations were reinterpreted by a neuromuscular neurologist and musculoskeletal radiologist, respectively, both blinded to our hypothesis. Results Seven patients met the inclusion criteria as having a non-traumatic isolated LTN palsy. Upon reinterpretation, all of them were found to have findings not consistent with an isolated LTN. On physical examination, three of them (43%) presented with weakness in muscles not innervated by the LTN. Four of them (57%) had additional EDX abnormalities beyond the distribution of the LTN. Five of them (71%) had MRI evidence of enlargement of nerves or denervation atrophy of muscles outside the innervation of the LNT, without evidence of compression of the LTN in the middle scalene muscle. Conclusion In our series, all 7 patients, originally diagnosed as having an isolated LTN, on reinterpretation, were found to have a more diffuse muscle/nerve involvement pattern, without MR findings to suggest nerve compression. These data strongly support an inflammatory pathophysiology.

Original languageEnglish (US)
Pages (from-to)1272-1279
Number of pages8
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Volume70
Issue number9
DOIs
StatePublished - Sep 1 2017

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Thoracic Nerves
Paralysis
Muscle Denervation
Muscles
Muscular Atrophy
Brachial Plexus
Muscle Weakness
Physical Examination
Inflammation

Keywords

  • Brachial plexitis
  • Fascicular constriction
  • Long thoracic
  • Nerve compression
  • Parsonage–Turner

ASJC Scopus subject areas

  • Surgery

Cite this

“Isolated long thoracic nerve palsy” : More than meets the eye. / Maldonado, Andrés A.; Zuckerman, Scott L.; Howe, B. Matthew; Mauermann, Michelle M; Spinner, Robert J.

In: Journal of Plastic, Reconstructive and Aesthetic Surgery, Vol. 70, No. 9, 01.09.2017, p. 1272-1279.

Research output: Contribution to journalArticle

Maldonado, Andrés A. ; Zuckerman, Scott L. ; Howe, B. Matthew ; Mauermann, Michelle M ; Spinner, Robert J. / “Isolated long thoracic nerve palsy” : More than meets the eye. In: Journal of Plastic, Reconstructive and Aesthetic Surgery. 2017 ; Vol. 70, No. 9. pp. 1272-1279.
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abstract = "Introduction Two main hypotheses have been proposed for the pathophysiology of long thoracic nerve (LTN) palsy: nerve compression and nerve inflammation. We hypothesized that critical reinterpretation of electrodiagnostic (EDX) studies and MRIs of patients with a diagnosis of non-traumatic isolated LTN palsy could provide insight into the pathophysiology and, potentially, the treatment. Material and methods A retrospective review was performed of all patients with a diagnosis of non-traumatic isolated LTN palsy and an EDX and brachial plexus or shoulder MRI studies performed at our institution. The original EDX studies and MR examinations were reinterpreted by a neuromuscular neurologist and musculoskeletal radiologist, respectively, both blinded to our hypothesis. Results Seven patients met the inclusion criteria as having a non-traumatic isolated LTN palsy. Upon reinterpretation, all of them were found to have findings not consistent with an isolated LTN. On physical examination, three of them (43{\%}) presented with weakness in muscles not innervated by the LTN. Four of them (57{\%}) had additional EDX abnormalities beyond the distribution of the LTN. Five of them (71{\%}) had MRI evidence of enlargement of nerves or denervation atrophy of muscles outside the innervation of the LNT, without evidence of compression of the LTN in the middle scalene muscle. Conclusion In our series, all 7 patients, originally diagnosed as having an isolated LTN, on reinterpretation, were found to have a more diffuse muscle/nerve involvement pattern, without MR findings to suggest nerve compression. These data strongly support an inflammatory pathophysiology.",
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