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The neurological examination
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Serratus anterior muscle (Figure 11.1a) Innervation: Long thoracic nerve (C5-C7).Function: Abduction of scapula.Physical examination: The patient pushes against resistance (e.g., the examiner’s hand or a wall). If the serratus anterior is paralyzed, winging of the scapula can be observed.
The shoulder and pectoral girdle
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
There are several causes of weakness or paralysis of the serratus anterior muscle: neuralgic amyotrophyinjury to the brachial plexus (a blow to the top of the shoulder, severe traction on the arm or carrying heavy loads on the shoulder)direct damage to the long thoracic nerve (for example, during radical mastectomy or first rib resections)fascioscapulohumeral muscular dystrophy.
Upper limb
Published in David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings, McMinn’s Concise Human Anatomy, 2017
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings
A 25-year-old man suffers from frequent shoulder dislocations. His orthopaedic surgeon recommends surgery to stabilise the shoulder. Which of the following structure(s) is most likely to be shortened during this surgery?Coracoclavicular ligament.Capsule of the acromioclavicular joint.Acromioclavicular ligament.Glenohumeral ligaments.Serratus anterior muscle.
Effectiveness of adding magnesium sulfate to bupivacaine in ultrasound guided serratus anterior plane block in patients undergoing modified radical mastectomy
Published in Egyptian Journal of Anaesthesia, 2023
Rehab Abd El-Raof Abd El-Aziz, Mohamed Frouk Asal, Ayman M. Maaly
A linear US probe (10–13 MHz) was positioned in a sagittal plane on the area of mid-clavicle. Counting of the ribs till reaching the fifth rib was done in the mid-axillary line. Then, the identification of the muscles lying over the fifth rib was done, and these muscles include latissimus dorsi, teres major and serratus anterior muscle. Advancement of the needle was progressed from posterior toward antero-caudal direction till reaching superficial to serratus anterior muscle. Then, injection of the prepared drugs was done under continuous US guidance. Pinprick test was examined within 20 minutes after the block, and if its recognition was delayed for more than 20 minutes in the dermatomes from T2 to T9, failure of the block was considered and exclusion of these patients from the study was done. [21] Anaesthesiologist who did not share in patients’ management prepared the drugs. The study is considered double blinded as the participants and the staff personnel shared in the techniques and data collection was blinded to the groups’ allocation.
“Undercutting of the corresponding rib”: a novel technique of increasing the length of donor in intercostal to musculocutaneous nerve transfer in brachial plexus injury
Published in British Journal of Neurosurgery, 2023
Kuntal Kanti Das, Jeena Joseph, Jaskaran Singh Gosal, Deepak Khatri, Pawan Verma, Awadhesh K Jaiswal, Arun K Srivastava, Sanjay Behari
An obvious concern with an undercutting of a rib is the potential injury to the proximal part of the nerve, excess pain and chronic nerve irritation on the cut bony edges/callous. Separation of the periosteum from the posterior surface of the rib and enhanced vision of the operating microscope (which can provide much better magnification than operating loops) allow preservation of the nerve during rib undercutting. Postoperative pain was not a particular problem in either of our cases. Moreover, only a small portion of the rib (around 1 cm of the lower half of the rib just proximal to the origin of serratus anterior muscle) is nibbled off which will not compromise the integrity of chest wall and respiratory function. We generously applied bone wax on the raw bone surface. This is known to prevent new bone formation.9 This, however, needs to be examined prospectively in the follow-up.
Reliability and validity of the Upper Limb Functional Test (ULIFT) for women after breast cancer surgery
Published in Disability and Rehabilitation, 2022
Clarissa Medeiros da Luz, Amably Cristiny Prim, Julia Deitos, Ailime Perito Feiber Heck, Thaís Lunardi Recchia, Anamaria Fleig Mayer
Before performing the ULIFT, the patients underwent a physical exam to investigate breast and arm sensitivity through the Semmes-Weinstein monofilament (SORRI-BAURU), assuming the violet monofilament (2.0 g) as a cut-off point, classifying the absence to responses to monofilament stimuli lower than violet as altered sensibility [37]. Ipsilateral arm lymphedema was identified and staged as the Simplified Clinical Classification for Lymphedema [38]. The paraesthesia of the region innervated by the intercostobrachial nerve was defined by the presence of burning pain, shooting pain, pressure sensation, and numbness in the lateral region of the thorax, medial region of arm and/or axilla, being assessed by inspection, palpation, and/or referenced by the patient [39,40]. Based on this evaluation, the participants were classified in presenting or not intercostobrachial nerve injury. Scapular winging was assessed by testing the serratus anterior muscle function as proposed by Hoppenfeld [41,42]. The test is considered positive (presence of winged scapula) on evidence of the medial portion of the scapula during movement [40,42].