Thoracodorsal nerve to long thoracic nerve transfer for scapula winging
Subscribe to get full access to this operation and the extensive Upper Limb & Hand Surgery Atlas.
Learn the Thoracodorsal nerve to long thoracic nerve transfer for scapula winging surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Thoracodorsal nerve to long thoracic nerve transfer for scapula winging surgical procedure.
The serratus anterior is supplied by the long thoracic nerve from C5,6 and 7. Long thoracic nerve palsy may follow traction injury, viral neuritis or nerve entrapment. Paralysis of the serratus anterior leads to winging of the scapula with poor scapula elevation, poor scapula control and impaired upper limb function, particularly with the arm in the forward elevated position. Exploration and decompression in the [osterior triangle of the neck, at the lateral border of the upper ribs or within the axilla may identify a cause of dysfunction that may be amenable to decompression. This is described elsewhere on OrthOracle. Failed recovery following decompression or persistent dysfunction at 6 months may be treated with a distal nerve transfer from the thoracodorsal nerve to the lower serratus anterior. Nerve transfer offers a reliable method of reinnervating paralysed muscles and utilises the proximity and redundancy of adjacent motor nerves close to the motor point of the paralysed muscle. Reinnervation distances are typically short resulting in good functional outcomes even when there is a delay to presentation or when other initial treatment modalities have failed.
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.