Systematic bifocal decompression for isolated long thoracic nerve paresis: A case series of 12 patients

To date, no consensus exists regarding the best surgical management of isolated, micro-traumatic long thoracic nerve (LTN) paresis. Our hypothesis was that a combined decompression of the LTN at two potential locations for entrapment would be effective in the management of dynamic LTN paresis. We re...

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Main Authors: Leonard Achenbach, Malo Le Hanneur, Roland S. Camenzind, Michael Bouyer, Pierre Pottecher, Thibault Lafosse
Format: Article
Language:English
Published: Elsevier 2022-03-01
Series:Interdisciplinary Neurosurgery
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S2214751921002966
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spelling doaj-30466f82b42c4d82bc742df9488c2aa22021-10-03T04:41:11ZengElsevierInterdisciplinary Neurosurgery2214-75192022-03-0127101384Systematic bifocal decompression for isolated long thoracic nerve paresis: A case series of 12 patientsLeonard Achenbach0Malo Le Hanneur1Roland S. Camenzind2Michael Bouyer3Pierre Pottecher4Thibault Lafosse5Hand, Upper Limb, Brachial Plexus, and Microsurgery Unit (PBMA), Clinique Générale d’Annecy, Annecy, France; Dpt. of Orthopedics, König-Ludwig-Haus, Julius-Maximilians-University Wuerzburg, Wuerzburg, Germany; Corresponding author at: Dpt. of Orthopedics, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, 97074 Würzburg, Germany.Hand to Shoulder Mediterranean Center, ELSAN, Clinique Bouchard, Marseille, FranceHand, Upper Limb, Brachial Plexus, and Microsurgery Unit (PBMA), Clinique Générale d’Annecy, Annecy, France; Dpt. of Orthopedics, University of Zurich, Balgrist University Hospital, Zurich, SwitzerlandHand, Upper Limb, Brachial Plexus, and Microsurgery Unit (PBMA), Clinique Générale d’Annecy, Annecy, FranceDpt. of Radiology, Clinique Générale d’Annecy, Annecy, FranceHand, Upper Limb, Brachial Plexus, and Microsurgery Unit (PBMA), Clinique Générale d’Annecy, Annecy, FranceTo date, no consensus exists regarding the best surgical management of isolated, micro-traumatic long thoracic nerve (LTN) paresis. Our hypothesis was that a combined decompression of the LTN at two potential locations for entrapment would be effective in the management of dynamic LTN paresis. We report on twelve patients with isolated LTN parersis, with tenderness at two entrapment sites, who underwent bifocal LTN decompression after undergoing unsuccessful conservative treatment for at least 6 months; all patients had preoperative electrodiagnostic studies that confirmed the paresis and ruled out peripheral neuritis. Clinical and electrical improvements were observed in eight patients (67%) regarding shoulder flexion, shoulder abduction, and Quick-DASH scores. Four patients (33%) did not improve after surgery. The results corroborate our hypothesis that a bifocal LTN decompression can be an effective and reliable therapeutic option in more than half of a very selective patient population suffering from serratus anterior muscle deficiency.http://www.sciencedirect.com/science/article/pii/S2214751921002966Entrapment, tractionSerratus anteriorScapular wingingScapula alataDyskinesiaPeripheral nerve
collection DOAJ
language English
format Article
sources DOAJ
author Leonard Achenbach
Malo Le Hanneur
Roland S. Camenzind
Michael Bouyer
Pierre Pottecher
Thibault Lafosse
spellingShingle Leonard Achenbach
Malo Le Hanneur
Roland S. Camenzind
Michael Bouyer
Pierre Pottecher
Thibault Lafosse
Systematic bifocal decompression for isolated long thoracic nerve paresis: A case series of 12 patients
Interdisciplinary Neurosurgery
Entrapment, traction
Serratus anterior
Scapular winging
Scapula alata
Dyskinesia
Peripheral nerve
author_facet Leonard Achenbach
Malo Le Hanneur
Roland S. Camenzind
Michael Bouyer
Pierre Pottecher
Thibault Lafosse
author_sort Leonard Achenbach
title Systematic bifocal decompression for isolated long thoracic nerve paresis: A case series of 12 patients
title_short Systematic bifocal decompression for isolated long thoracic nerve paresis: A case series of 12 patients
title_full Systematic bifocal decompression for isolated long thoracic nerve paresis: A case series of 12 patients
title_fullStr Systematic bifocal decompression for isolated long thoracic nerve paresis: A case series of 12 patients
title_full_unstemmed Systematic bifocal decompression for isolated long thoracic nerve paresis: A case series of 12 patients
title_sort systematic bifocal decompression for isolated long thoracic nerve paresis: a case series of 12 patients
publisher Elsevier
series Interdisciplinary Neurosurgery
issn 2214-7519
publishDate 2022-03-01
description To date, no consensus exists regarding the best surgical management of isolated, micro-traumatic long thoracic nerve (LTN) paresis. Our hypothesis was that a combined decompression of the LTN at two potential locations for entrapment would be effective in the management of dynamic LTN paresis. We report on twelve patients with isolated LTN parersis, with tenderness at two entrapment sites, who underwent bifocal LTN decompression after undergoing unsuccessful conservative treatment for at least 6 months; all patients had preoperative electrodiagnostic studies that confirmed the paresis and ruled out peripheral neuritis. Clinical and electrical improvements were observed in eight patients (67%) regarding shoulder flexion, shoulder abduction, and Quick-DASH scores. Four patients (33%) did not improve after surgery. The results corroborate our hypothesis that a bifocal LTN decompression can be an effective and reliable therapeutic option in more than half of a very selective patient population suffering from serratus anterior muscle deficiency.
topic Entrapment, traction
Serratus anterior
Scapular winging
Scapula alata
Dyskinesia
Peripheral nerve
url http://www.sciencedirect.com/science/article/pii/S2214751921002966
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