Outcomes of endoscopic, thoracic segment long thoracic nerve decompression

Axillary and inferior periscapular pain often presents with scapulothoracic abnormal motion and observable winging and can be debilitating for patients. Our hypothesis is that endoscopic long thoracic nerve (LTN) decompression in the thoracic segment is effective at improving axillary and inferior periscapular border pain.

A retrospective chart review was performed of all patients diagnosed with persistent axillary and inferior periscapular border pain receiving endoscopic LTN decompression at a single institution, performed by 2 surgeons between 2020 and 2024. Patient demographics and patient pre- and postoperative patient-reported outcome measures were collected.

Thirty-one patients receiving endoscopic LTN decompression were identified and included for analysis. The average follow-up was 25.1 ± 10.9 months, with an average patient age of 45.2 ± 18.1 years. Fifteen (n = 15/31; 48.4%) had prior ipsilateral upper-extremity surgery. Nineteen (n = 19/31; 61.2%) patients received a concomitant pectoralis minor release, 11 (n = 11/31; 35.5%) arthroscopic brachial plexus neurolysis, 10 (n = 10/31; 32.2%) arthroscopic scapulothoracic decompression, and 2 biceps tenodesis (n = 2/31; 6.5%) at the time of their arthroscopic LTN decompression. Visual analog scores (VAS) (7.7 ± 2.1 vs. 2.7 ± 2.7; P < .001) and subjective shoulder value (38.0 ± 24.2% vs. 85.6 ± 8.2%; P = .02) significantly improved after surgery. Patient-Reported Outcomes Measurement Information System (PROMIS) Short Form 7a (P = .35), PROMIS global physical (P = .58), PROMIS mental health (P = .65), and quick disabilities of the arm, shoulder, and hand (P = .11) did not significantly change after surgery. Measured forward elevation (127 ± 41° vs. 157 ± 10°; P = .003), abduction (117 ± 29° vs. 136 ± 14°; P = .01), and external rotation (54 ± 19° vs. 58 ± 4°; P = .009) significantly improved after surgery, while internal rotation (L1 ± 3 levels vs. T11 ± 2 levels; P = .11) remained unchanged. There were 4 (n = 4/31; 12.9%) complications characterized as persistent pain after surgery. There was one revision endoscopic LTN release (n = 1/31; 3.2%). There was no predictive patient (age, sex, body mass index, American Society of Anesthesiologists score, smoking status, diabetes, prior ipsilateral surgery) or surgical (operating room time) factors predisposing to surgical complications using logistic regression.

Thoracic-based, endoscopic decompression of the LTN improves pain, patient-reported outcome measures, and range of motion with minimal complications. Further study is required to determine long-term pain relief and outcomes.