Summary

Endoscopic release of the long thoracic nerve may be a less invasive method to treat scapualr winging secondary to serratus nerve palsy.

Abstract

Endoscopic Long Thoracic Nerve Release for Scapular Winging

Background

Serratus palsy secondary to long thoracic nerve pathology can result in winging, pain, and shoulder dysfunction. Common surgical treatment involves pectoralis major transfer. While this is an effective solution, the operation can be morbid. We present an alternate approach that involves an endoscopic decompression of the long thoracic nerve.

Materials And Methods

Between June 2014 and September 2016, ten patients presented with scapular winging secondary to serratus palsy. All patients had an emg; 9 had positive emg changes for long thoracic nerve palsy and had failed at least one year of conservative treatment. All patients underwent an endoscopic release of the long thoracic nerve along the superficial surface of the serratus. All patients were available for clinical follow up at an average of 18 months (range 6-24 months).

Results

There were six women and four men; mean age is 49 (range 25-61). All patients reported subjective improvement at their first postoperative visit. By six weeks rage of motion had improved significantly. Average pre op forward flexion was 105o and abduction was 83o; post op forward flexion and abduction was 144o and 134o, respectively.

Conclusion

Endoscopic long thoracic nerve release can be a successful option for the treatment of scapular winging caused by serratus palsy. All patients in this group had significant improvement in their pain and range of motion. No patient has required a pectoralis transfer. One patient developed a post operative hematoma that required drainage.