Brachial plexus exploration and long thoracic nerve decompression surgical technique
Subscribe to get full access to this operation and the extensive Upper Limb & Hand Surgery Atlas.
Learn the Brachial plexus exploration and long thoracic nerve decompression surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Brachial plexus exploration and long thoracic nerve decompression surgical procedure.
The long thoracic nerve arises from the C5,6 and 7 roots in the neck and passes posterior to the brachial plexus across the lateral border ofthe first rib to enter the costoclavicular space. The anatomy has many variants and these abnormal innervation branches render the nerve susceptible to traction injury, compression or iatrogenous injury.
Long thoracic nerve palsy results in paralysis of the serratus anterior muscle with loss of scapula stabilisation, elevation and rotation. Diagnosis of the condition is straightforward due to the obvious wasting of the muscle and the winging of the medial border of the scapula on arm lateral and forward elevation.
The underlying pathology is difficult to diagnose. Common causes are neurogenic from viral neuritis, injury, traction or compression. Neuritis may have a painful prodrome and wider changes within the plexus on electormyography. The differential is myopathic winging due to primary motor pathology and weakness. EMG is useful in diagnosis and planning surgery. Tenderness over the course of the nerve at the scalene interval in the posterior triangle , the apex of the axilla or the mid-axillary line can guide the surgeon towards the primary site of pathology for exploration and decompression.
The case presented here had tenderness over the scalene interval and the lateral border of the first rib and so the first part of the decompression was to explore and stimulate the nerve origin and proximal course in the neck.
Author: Dominic Power FRCS Orth, Consultant Hand and Peripheral Nerve Surgeon
Institution: Peripheral Nerve Injury Service, Birmingham Hand Centre, Queen Elizabeth Hospital, UK
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
Our content is designed for both Surgeons in independent practice and Surgeons in training.