Massage therapy · Kitchener–WaterlooLong Thoracic Nerve Palsy

Damage can also occur after certain surgical procedures, particularly those involving the chest, such as breast surgery that removes lymph nodes from the armpit. Other reported causes include manipulation of the neck, using a single crutch under one arm, and viral illnesses. Sometimes no cause is found (Martin and Fish, 2008).

Only a doctor or healthcare practitioner can diagnose long thoracic nerve palsy. Usually, this involves taking a medical history, including questions about past or present injuries, and a physical examination, which may include your doctor asking you to make specific movements to check your shoulder blade. Electromyography (EMG), a test that records the electrical activity in muscles, is the main test used to confirm the diagnosis, and a nerve conduction study may help to show how severe the problem is. Scans such as MRI or CT are rarely needed but may be used to rule out other problems (Martin and Fish, 2008).

Recommended treatments for long thoracic nerve palsy can vary depending on the severity of the symptoms and the cause. Non-surgical treatment, such as physiotherapy, is usually tried first (Vetter et al., 2017), and most cases recover on their own within about 24 months (Martin and Fish, 2008).

1. Avoid Overstretching

Avoid overstretching the serratus anterior muscle, because stretching the weakened muscle can slow down recovery (Martin and Fish, 2008).

2. Posture

Posture can be important for the position of the shoulder blade. When the shoulders drop too far forwards, the shoulder blade sticks out further backwards, making winging more noticeable. Improving your posture with good habits and exercises may help.

3. Therapy

Physiotherapy, osteopathy and sports massage may help to ease symptoms and improve posture.

Options outside my scope

• Pain relief: if your shoulder is painful, your family doctor or nurse practitioner can advise you on suitable pain relief.
• Winger's brace: a brace that presses the shoulder blade against the back of the chest wall to stop the weakened muscle being overstretched (Martin and Fish, 2008).
• Muscle or nerve transfer surgery: an operation that moves a nearby muscle (usually part of the large chest muscle, pectoralis major) or a nerve to take over the job of the weakened serratus anterior. Surgery is usually only considered if winging continues after a long period of non-surgical treatment (Martin and Fish, 2008; Vetter et al., 2017).
• Scapulothoracic fusion: an operation that fixes the shoulder blade to the ribs underneath it (the third to sixth ribs) (Vetter et al., 2017). It permanently limits how high you can lift your arm, so it is usually kept for especially difficult cases or when other treatments have not worked (Martin and Fish, 2008).

How I can help (see the My Approach tab)

• Hands-on work for the neck, upper back and shoulder muscles that are working overtime
• Gentle range-of-movement work, then strengthening for the muscles around your shoulder blade
• Posture advice and a home programme that avoids overstretching the weak muscle

In many cases, it just takes time. Letting the body "sort itself out" is often the main part of recovery, and expecting it to take time will help you to be realistic about the time-frames of recovery.

If the weakness or winging gets worse, see your doctor.