Martinez Juan Pablo, Lovaglio Ana, Masi Gilda Di, Mandolesi Jorge, Zancolli Pablo, Socolovsky Mariano
Department of Neurosurgery, Hospital Universitario Fundacion Favaloro, Buenos Aires, Argentina.
Department of Hand Surgery, Hospital Universitario Fundacion Favaloro, Buenos Aires, Argentina.
Surg Neurol Int. 2024 May 17;15:163. doi: 10.25259/SNI_91_2024. eCollection 2024.
Traumatic injury to the long thoracic nerve causes paralysis of the serratus muscle, clinically expressed as winged scapula and functional impairment of the shoulder girdle. Treatment varies according to the severity of the injury, with a focus on early intervention for best results; however, the therapeutic approach remains a challenge at present.
We present the case of a 32-year-old male patient, athlete, right-handed, presented with bilateral paresis predominantly in the right arm, associated with paresthesia and changes in the coloring of the upper limbs. After being diagnosed with Thoracic Outlet Syndrome and undergoing surgery, vascular symptoms persisted with a significant loss of strength in the right shoulder. Winged scapula was observed and structural lesions were excluded on magnetic resonance imaging. Electromyographic studies confirmed the presumption of traumatic nerve involvement of the long thoracic nerve. Notwithstanding 6 months of physical therapy, there was no improvement, so a nerve transfer from the thoracodorsal nerve to the right long thoracic nerve was chosen. At 12 months, complete resolution of the winged scapula and functional recovery were observed. The patient also experienced a decrease in preoperative pain from 5/10 to 2/10 on the visual analog scale.
Nerve transfer from the thoracodorsal nerve to the long thoracic nerve is a safe and effective technique to treat winged scapula due to long thoracic nerve injury.
胸长神经的创伤性损伤会导致前锯肌麻痹，临床表现为翼状肩胛和肩胛带功能障碍。治疗方法因损伤严重程度而异，重点是早期干预以获得最佳效果；然而，目前的治疗方法仍然是一个挑战。
我们介绍了一名32岁男性患者的病例，该患者为运动员，右利手，主要表现为双侧上肢无力，伴有感觉异常和上肢肤色改变。在被诊断为胸廓出口综合征并接受手术后，血管症状持续存在，右肩部力量明显丧失。观察到翼状肩胛，磁共振成像排除了结构性病变。肌电图研究证实了胸长神经创伤性神经受累的推测。尽管进行了6个月的物理治疗，但没有改善，因此选择了将胸背神经转移至右胸长神经。12个月时，观察到翼状肩胛完全消失且功能恢复。患者术前疼痛在视觉模拟量表上也从5/10降至2/10。
将胸背神经转移至胸长神经是治疗因胸长神经损伤导致的翼状肩胛的一种安全有效的技术。
