Isolated Paralysis of the Serratus Anterior Muscle Successfully Treated by Surgical Release of the Distal Portion of the Long Thoracic Nerve

Objectives: Isolated paralysis of the serratus anterior (SA) muscle had been reported, especially in athletes. During SA fascial flap dissections, we observed that fascial and vascular structures can mechanically constrain the thoracic portion of the long thoracic nerve (LTN). Here, we assess the results of neurolysis of the thoracic segment of the LTN.

Methods: A prospective multicenter study was conducted between December 1999 and June 2004. Every case of isolated palsy of the SA was included, after a Parsonage-Turner syndrome has been ruled out. Eighteen consecutive cases underwent such neurolysis. There were 14 men and 4 women. Their mean age was 30 years (17 to 49).

Results: The operation took place 16.4 months (range, 4-72 months) after the onset of palsy. Pain relief usually occurred during the first postoperative month. At the longest follow-up most patients had recovered completely.

Conclusions: In the absence of spontaneous recovery from traumatic palsy, surgical release of the distal segment of the LTN is a minimally invasive, safe and efficient procedure. Results were best when surgery was performed within six months of the initial paralysis.