長胸神経・前鋸筋の解剖と臨床

概要

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The purposes of this study were (1) to clarify the trajectory of the long thoracic nerve (LTN), (2) to investigate the anatomy and innervations of the 3 parts of the serratus anterior (SA), and (3) to analyze clinical features of 450 shoulders with LTN palsy. We collected specimens from 70 sides of 35 cadavers. The LTN consisted of C5, C6, and C7 in 87% of sides, C5 and /or C6 penetrated the scalenus medius in 64 dissections, and descended for 24 cm posterolateral thorax. The upper part of the SA tilted the scapula anteriorly, the middle abducted, and lower rotated upwardly. The affected sides were right in 337 shoulders, left in 77, and both in 5. Symptoms of LTN palsy were various: pain; weakness; unable to elevate; numbness; not being able to sleep on the affected side; and instability overhead. The 3 critical points of The LTN have been documented in the literature: in the scalenus medius; on the 2nd rib; and the fibrous band beneath the brachial plexus. Surgical treatment of LTN palsy identified the exit of the SA as the true entrapment point of the nerve. The outcome of surgical intervention was better than that of conservative treatment, therefore, decompression of the nerve is recommended as an interventional option of LTN palsy.
2010-08-04