Postoperative isolated dysfunction of the long thoracic nerve: a rare entity of uncertain etiology

A "winged" scapula is a rare, poorly understood, and potentially disabling curiosity following anesthesia and surgery. It is produced by dysfunction of the long thoracic nerve and consequent paralysis of the serratus anterior muscle. A survey of senior anesthesiologists indicated a consistent lack of familiarity with the entity. This article presents six cases of postoperative long thoracic nerve palsy. In a literature review of 111 instances of long thoracic nerve palsy, 51 were trauma-related, 47 were either idiopathic or of debatable origin, and 13 appeared following a surgical or obstetrical procedure. Unprovable etiologic contentions were frequent. Considerations of the etiologies of postoperative long thoracic nerve palsies must include a coincidental infectious neuropathy ("neuralgic amyotrophy") as a valid alternative to the assertion that a preventable injury occurred during anesthesia.