Ultrasound evaluation and ultrasound-guided injection in long thoracic nerve neuropathy: a technical approach

To present a reproducible ultrasound-guided approach for the identification and injection of the long thoracic nerve (LTN) in patients with burning axillary pain.

High-resolution ultrasound was used to visualize the LTN along its superficial course, from its emergence through the middle scalene muscle to its trajectory over the serratus anterior muscle. It is used a high-frequency linear transducer (10-18 MHz) with patients positioned supine or lateral decubitus with arm abduction. Under sterile conditions, it is performed perineural injections both proximal to the cervical spine and distally to the axilla, using the in-plane technique.

The LTN was identified at both the supraclavicular and lateral thoracic levels. Ultrasound guidance allowed for accurate needle placement and perineural distribution of the injectate. The procedure has proven feasible, safe, and reproducible in the clinical setting.

Ultrasound-guided injection of the long thoracic nerve is a precise and minimally invasive technique that combines precise diagnostic confirmation with lasting therapeutic benefit. It represents a valuable option in the management of long thoracic nerve neuropathy and may reduce the need for systemic medications. Further studies are needed to verify its long-term efficacy and define standardized protocols.