Skip to main content
AAPM&R Events Main banner
JFK Johnson
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
In-Person
In-Person
On Demand
On Demand
Live Stream
Live Stream
Invite Only
Invite Only
Ticketed
Ticketed
Coffee Break
Coffee Break
Meal
Meal
Reception
Reception
Back

General Rehabilitation

(Kiosk 1) Iatrogenic Long Thoracic Nerve Injury Following Thoracostomy

Saturday, November 18, 2023
8:00 AM – 9:15 AM CT

    Primary Author(s)

  • Michael Juszczak, MD

    Resident Physician
    Tower Health PM&R Program
    Reading, Pennsylvania

    • Co-Author(s)

  • JG

    John H. Gallagher, III, MD

    Resident
    Tower Health PM&R Program
    Stewartsville, New Jersey

  • JK

    Joseph Kenney, MD

    Resident Physician
    Tower Health PM&R Program
    Sinking Spring, Pennsylvania

  • KC

    Kelley Crozier, MBA, MD

    Chair, Department of Physical Medicine & Rehabilitation
    Tower Health PM&R Program
    Wyomissing, Pennsylvania

  • PB

    Paul Brockman, MD

    Tower, Reading Hospital specialists physical medicine rehabilitation certified AANEM
    Reading Hospital and Med Center
    Reading, Pennsylvania

Case Diagnosis: Iatrogenic Long Thoracic Nerve Injury Following Thoracostomy

Case Description or Program Description: A 35 year old male with a prior spontaneous pneumothorax resulting in thoracostomy presented to clinic with numbness/tingling in his right chest wall and weakness in his right arm/shoulder resulting in scapular winging. Symptoms were present since thoracostomy 2 years prior and mildly improved after beginning a supervised exercise program. He continued to experience weakness with overhead exercises and has remained unable to lift more then 10 pounds for the previous 18 months. He denied new pain or trauma since symptom onset.

Setting: Outpatient Physiatry Clinic

Assessment/Results: Nerve conduction studies of the right upper extremity (R UE) showed a 5% reduced amplitude of the right long thoracic nerve (R LTN) compared to the left long thoracic nerve (L LTN). EMG studies of the right serratus anterior revealed complex motor units with polyphasic waveforms (3+) indicative of chronic injury with reinnervation. The R LTN showed increased duration (8.5 ms vs 3.8 ms) and reduced velocity (36 m/s vs 68 m/s) of the sensory nerve action potential when compared to the L LTN. Findings are indicative of a significant reduction in motor unit action potentials and recruitment compatible with chronic injury to the LTN. All other R UE muscles tested revealed normal findings. There was no evidence of brachial plexopathy, radiculopathy, or myopathy.

Discussion (relevance): Clinical and electrodiagnostic testing is consistent with denervation of the serratus anterior and chronic R LTN injury secondary to thoracostomy. Although regeneration is unlikely given the chronicity of the injury, it is paramount to improve the function of the accessory muscles that stabilize the scapula to reduce the likelihood of secondary complications such as brachial plexus injury, adhesive capsulitis, & subacromial impingement.

Conclusions: This case demonstrates that injury to the LTN resulting in scapular winging is a rare complication that can arise following thoracostomy.