Long thoracic nerve lesions

Causes

• Trauma on the shoulder usually by downward traction (“rucksack paralysis”).
• Iatrogenic (e.g thoracotomy, mastectomy, axillary node dissection, plexus anesthesia).
• Occasionally seen as isolated neuropathy in Parsonage-Turner neuralgic amyotrophy.
• Familial brachial plexus neuropathy.

Symptoms & signs

• Winged scapula.
• Weakness and easy fatigue when raising arm above head.
• Pain radiating to neck and upper arm.

Examination

• Have patient push forward with palm against resistance and check for scapular winging.