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Sonoanatomy revisited: the long thoracic nerve.

Ke-Vin Chang1, Wei-Ting Wu2, Kamal Mezian3

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This study details a step-by-step ultrasound scanning method to trace the entire long thoracic nerve (LTN) course. This technique aids in identifying the LTN and preventing injury during procedures like nerve blocks.

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Area of Science:

  • Anatomy
  • Neurology
  • Medical Imaging

Background:

  • The long thoracic nerve (LTN) originates from cervical roots C5-C7, innervating the serratus anterior muscle.
  • LTN neuropathy can cause scapular winging, often resulting from iatrogenic injury during cervical nerve root or brachial plexus blocks.
  • Existing literature describes LTN sonoanatomy, but lacks detailed guidance on tracing its complete path.

Purpose of the Study:

  • To present a systematic ultrasound scanning protocol for visualizing the entire course of the long thoracic nerve (LTN).
  • To provide clinicians with a reproducible method for identifying the LTN from its origin to its distal segments.

Main Methods:

  • A detailed ultrasound-guided scanning approach was developed to follow the long thoracic nerve (LTN).
  • The method emphasizes gradual identification of the nerve's trajectory from the brachial plexus origins to the serratus anterior muscle.

Main Results:

  • The proposed scanning method allows for the comprehensive visualization of the long thoracic nerve (LTN).
  • This technique facilitates the identification of the LTN in relation to surrounding anatomical structures.

Conclusions:

  • A systematic ultrasound scanning protocol can effectively delineate the entire course of the long thoracic nerve (LTN).
  • This method enhances the ability to locate the LTN, potentially reducing the risk of iatrogenic injury during regional anesthesia procedures.