Long thoracic nerve palsy

What is it?
The long thoracic nerve provides power to the main muscle which stabilizes the scapula. That muscle is called the serratus anterior, and when the nerve is injured, the shoulder blade sticks out in the back.

What does this feel like?
This causes a dull aching pain sometimes, but usually loss of throwing speed and loss of strength are noted. It is very difficult to throw a baseball or softball effectively with a palsied long thoracic nerve.

How is it treated?
Nonoperative treatment is usually successful, but can take 9-12 months, and full recovery might not occur for 2 years. Rest does help, so time off throwing is recommended. Therapy is prescribed. At first, therapy is to maintain motion. Then exercises progress to strengthen other muscles which substitute for the serratus anterior, and finally to strengthen the recovering serratus anterior. Finally there is rehabilitation of throwing-specific muscles and an interval throwing program.

Operative treatment is required in the rare case that recovery does not occur by 2 years. Surgery is tendon transfers, whereby other muscles around the scapula are cut off their normal attachments, and then reattached to the scapula in different places, so as to permanently substitute for the funcion of the serratus anterior. This is a very uncommon surgery.

How long will I be out of throwing?
It can be as short as a few months if the nerve and muscle are recovering. In rare cases, it can take 2 years to determine no recovery is occuring, and then another year for recovery from the tendon transfer surgery.