There are several different kinds of surgery that can be used to address winged scapula. One involves transferring the pectoralis major tendon to the scapula so it functions as your serratus. Unless you go to the gym to build up your muscles, you may not recognize the name serratus anterior. Caitilin Kelly, MD, is a clinical physician at Indiana University Health Bloomington Hospital and is board-certified in internal medicine. Injury to this nerve may cause limited or abnormal motion in your shoulder and shoulder blade, including difficulty raising your arm during overhead reaching. 2017 Dec 7. doi:10.7759/cureus.1923, Vetter M, Charran O, Yilmaz E, et al. In primitive life forms, the main function of the axioscapular group is to control the movements of the vertebral border of the scapula: fibers concerned with the dorsal movement of scapula evolved into the rhomboids, those with ventral motion into serratus anterior, and those with cranial movements into levator scapulae. Additionally, all three parts can lift the ribs when the shoulder girdle is fixed, and thus assist in respiration.[1]. Diagnosis of a long thoracic nerve injury typically is made by clinical examination. If you suspect winged scapula, a visit to your physician is in order, where he or she can assess your condition and determine if you have a long thoracic nerve injury. Lung K, Lui F. Anatomy, thorax, serratus anterior muscles. Reprinted from Gray H, Lewis WH. Clearly visible serratus anterior muscle of the artistic gymnast Calvin Currie during preparation of the parallel bars at the Austrian Future Cup in Linz. Treasure Island (FL): StatPearls Publishing; 2019 Jan. 4). Understanding the anatomy and function of the long thoracic nerve can help you make informed health care decisions after an injury to the nerve. Treasure Island (FL): StatPearls Publishing; 2019 Jan. Berthold JB, Burg TM, Nussbaum RP. 2017;117(2):133-137. doi:10.7556/jaoa.2017.025, Vetter M, Charran O, Yilmaz E, et al. Journal of Anaesthesia and Critical Care Case Reports Sep-Dec 2017; 3(1):24-26. superficial to serratus anterior. Im weiteren Verlauf nach distal gibt jeder Truncus einen vorderen und einen hinteren Ast ab (Divisiones anteriores et posteriores), die wiederum die Faszikel (Bündel) oder Sekundärstämme bilden. Methods: This prospective, randomized, active-intervention-controlled, subject-assessor-blinded, single-center, parallel-group trial allocated 18- to 80-year-old patients with American Society of Anesthesiologists status I to III to receive either SAPB or ICNB in a 1:1 ratio. Images. The serratus anterior muscle inserts exactly at the front border of the scapula, or shoulder blade. Dieser Muskel befestigt bei Säugetieren den Arm beziehungsweise die Vordergliedmaße am Brustkorb. Funktion Der M. Serratus bewirkt in seiner Gesamtheit eine Verschiebung der Scapula nach seitlich-vorne. Long thoracic nerve injury can occur acutely from a blow to the shoulder, or with activities involving chronic repetitive traction on the nerve (e.g., tennis, swimming, baseball). It is considered one of the four muscles of the pectoral region. Perform 10 to 15 repetitions. However, when the inferior and superior parts act together, they keep the scapula pressed against the thorax together with the rhomboids and therefore these parts also act as synergists to the rhomboids. The spinal accessory nerve innervates th… Origins: External lateral surfaces and superior borders of the first through eighth ribs. Since the long thoracic nerve is superficially located on the lateral side of your chest, it may be subject to injury during sports or surgical procedures. Serratus anterior normally originates by nine or ten slips (muscle branches) from either the first to ninth ribs or the first to eighth ribs. The performance of such a nerve conduction study is not usual and requires a well-trained physician. Pain will be experienced on the side of the ribca Es handelt sich dabei um den Nervus thoracicus longus, ein Nerv, der den Musculus serratus anterior versorgt. It is utilized vigorously in push-ups and bench presses. As such, the muscle is an antagonist to the rhomboids. The Serratus Anterior Plane Block (SAPB) is a modification of the PECS blocks. Attachments: Origin: The lower part of the ligamentum nuchae, and the cervical and thoracic spines (usually C7 – T3). This manifests as a visual bump in your back where your shoulder blade resides.2 One common cause of a serratus anterior injury is a problem with the long thoracic nerve.3 This nerve resides near your armpit, and it may be damaged during surgical procedures involving your shoulder. An electromyographic (EMG) test may be done to examine the function of the long thoracic nerve. It supplies motor function to the serratus anterior muscle of your thorax, helping to stabilize your shoulder blade. This nerve characteristically arises from the anterior rami of three spinal nerve roots: the fifth, sixth, and seventh cervical nerves (C5-C7), although the root from C7 may be absent. [Updated 2019 Feb 5]. The long thoracic nerve innervates the serratus anterior. Serratus Anterior Plane (SAP) Nerve Block for Ribs on POCUS 62M with severe chest wall abrasions, clavicle, rib and scapula fx sustained while riding a bicycle with a weed eater balanced on the handlebars! This nerve characteristically arises from the anterior rami of three spinal nerve roots: the fifth, sixth, and seventh cervical nerves (C5-C7) although the root from C7 may be absent. Nerve: Long thoracic nerve arising directly from the anterior rami of nerve roots of C5, C6, C7 and occasionally C8 (8, 11, 23). It helps to move the shoulder blade and stabilizes it during shoulder motions. After surgery, you will likely wear a sling on your arm for a few weeks, and then gentle range of motion (ROM) exercises will be initiated. The long thoracic nerve supplies motor function to the serratus anterior muscle. Place both hands on the wall, and gently push against it. Perform 10 to 15 repetitions. We performed a systematic review to establish the current state of evidence for the analgesic role of these fascial plane blocks in these clinical settings. - UAB Emergency Ultrasound @UAB_Sono #Serratus #Anterior #SAP #Ribs #NerveBlock #POCUS #ultrasound #clinical Weakness or paralysis of the serratus anterior muscle will result in a winged scapula. This innervation supplies from your 5th through 7th cervical spine and is important for the mobility of your neck. Long thoracic nerve alters the function of the serratus anterior muscle, causing scapular weakness and elevation. It is utilized vigorously in push-ups and bench presses. Serratus Anterior: The Serratus Anterior muscle is utilized in activities which draw the scapula forwards. The long thoracic nerve supplies motor function to the serratus anterior muscle. Injuries to the long thoracic nerve cause winging of the scapula, especially with the arm in anterior … [4], All three parts described above pull the scapula forward around the thorax, which is essential for anteversion of the arm. The roots from C5 and C6 pierce through the scalenus medius, while the C7 root passes in front of the muscle. The serratus anterior a muscle that originates on the top surface of the eight or nine upper ribs. Peripheral Nerve Stimulator guided serratus anterior plane block: A novel approach to the chest wall block. The long thoracic nerve arises from the ventral rami of cervical nerves C5, C6, and C7. In some people, the root from C7 is absent, and in others, there is a small root of the nerve arising from C8. When it contracts, it pulls your shoulder blade against your ribs and thorax. J Am Osteopath Assoc. Description: Origin: Anterolateral surface of first 8 or 9 ribs just anterior to the mid-axillary line Insertion: Anterior surface of the medial margin of the scapula from the superior angle to the inferior angle Actions: Abducts the scapula Nerve supply: Long thoracic nerve Blood supply: Branches of the axillary artery. Attachment point for the SA is seen on the left border. Like the PECS blocks, the SAPB was developed as an alternative to thoracic epidural, paravertebral, intercostal, and intrapleural blocks. When the condition is just starting, some individuals will suffer more intense nerve pain for a few days, and their pain will settle down as the paralysis progresses. Winged scapula: A comprehensive review of surgical treatment. Perform a pushup, and then press up further, allowing your shoulder blades to wrap around your thorax. The serratus plane block is easy and appears to work very well for rib fracture analgesia by blocking the lateral intercostal nerves. Methods: Serratus anterior function wa s restored through decompress ion, neurolysis, and tetanic electrical stimulation of the long thoracic nerve. Educational Video created by Dr. Sanjoy Sanyal; Professor, Department Chair, Surgeon, Neuroscientist and Medical Informatician in the Western Hemisphere. Not to mention, what it’s responsible for doing. Lie on your back and raise both arms up towards the ceiling. The serratus anterior is one of the most overlooked muscles of the body. To sustain these forces, the ribs have a pronounced curvature and are supported by the clavicle. [3], The serratus anterior is innervated by the long thoracic nerve (Nerve of Bell), a branch of the brachial plexus. This innervation supplies from your 5 th through 7 th cervical spine and is important for the mobility of your neck. 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