WINGING OF THE SCAPULA.,LONG THORACIC NERVE - Everything You Need To Know - Dr. Nabil Ebraheim скачать в хорошем качестве

WINGING OF THE SCAPULA.,LONG THORACIC NERVE - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describing the cause of winging of the scapula and treatment methods for this deformity. What causes medial winging of the scapula? Most commonly caused by deficit in the serratus anterior muscle due to impingement injury of the long thoracic nerve. The long thoracic nerve arises from three nerve roots, the fifth, sixth and seventh cranial nerves.the long thoracic nerve then passes between the clavicle and first rib, then down along the lateral chest wall giving innervation to the serratus anterior muscle. The serratus anterior muscle attaches to the medial anterior aspect of the scapula and anchors the scapular against the rib cage. The scapula is the largest bone of the shoulder complex and has the greatest number of muscles attached to it. Although these muscles may work together or oppose each other, they coordinate their function to work in harmony as a team. The long thoracic nerve can be injured by: •Trauma •Pressure •Neuritis/inflammation Signs/symptoms of long thoracic nerve injury •Winging of the scapula •Pain •Weakness •Difficulty elevating the arm •Spasms: periscapular muscles trying to compensate for deformity. •Cosmetic deformity Clinical evaluation tests Wall test The patient is asked to face a wall, standing about two feet from the wall and then push against the wall with flat palms at waist level in order to identify a long thoracic nerve injury. Resistance of forward flexion test This is the resisted forward flexion test in which the patient resists the examiner’s attempt to bring down the forward flexed upper limbs. Treatment of scapular winging Nonoperative •Observation for a minimal of 18 months-wait for nerve to recover without surgery. •MRI to indicate if a lesion is pressing on the nerve. •Muscle tests and EMG •Serratus anterior strengthening. Operative •Pectoralis major transfer. special thanks for NATHAN ELKINS FOR HIS CONTRIBUTION TO THIS VIDEO