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MR neurography (MRN) of the long thoracic nerve: retrospective review of clinical findings and imaging results at our institution over 4 years

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Abstract

Objective

Long thoracic nerve (LTN) injury can result in ipsilateral serratus anterior palsy and scapular winging. Traditional means of evaluating patients with suspected LTN injury include physical examination and electrodiagnostic studies. The purpose of our study is to describe high-resolution magnetic resonance (MR) findings in patients with clinical suspicion of LTN neuropathy.

Methods

In this HIPAA-compliant, IRB-approved, retrospective study, two radiologists reviewed MR imaging performed for long thoracic neuropathy. Clinical presentation, electrodiagnostic studies and MR imaging of 20 subjects [mean age 37 ± 13 years; 25% (5/20) female] were reviewed. Observers reviewed MR imaging for LTN signal intensity, size, course, presence or absence of mass and secondary findings [skeletal muscle denervation (serratus anterior, trapezius, rhomboid) and scapular winging]. Descriptive statistics were reported.

Results

Clinical indications included trauma (n = 5), hereditary neuropathy (n = 1), pain (n = 8), winged scapula (n = 6), brachial plexitis (n = 4) and mass (n = 1). Electrodiagnostic testing (n = 7) was positive for serratus anterior denervation in three subjects. Abnormal LTN signal intensity, size, course or mass was present in 0/20. Secondary findings included skeletal muscle denervation in the serratus anterior in 40% (8/20), trapezius in 20% (4/20) and rhomboid in 20% (4/20). In 5% (1/20), an osteochondroma simulated a winged scapula, and in 2/20 (10%) MR showed scapular winging.

Conclusions

High-resolution MR imaging is limited in its ability to visualize the long thoracic nerve directly, but does reveal secondary signs that can confirm a clinical suspicion of LTN injury.

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References

  1. Chhabra A, Thawait GK, Soldatos T, et al. High resolution 3T MR neurography of the brachial plexus and its branches with emphasis on 3D imaging. AJNR. 2013;34:486–97.

    Article  CAS  PubMed  Google Scholar 

  2. Nguyen C, Guerini H, Zauderer J, et al. Magnetic resonance imaging of dynamic scapular winging secondary to a lesion of the long thoracic nerve. Joint Bone Spine. 2016;83(6):747–9.

    Article  PubMed  Google Scholar 

  3. Lieba-Samal D, Morgenbesser J, Moritz T, et al. Visualization of the long thoracic nerve using high-resolution sonography. Ultraschall Med. 2015;36(3):264–9.

    CAS  PubMed  Google Scholar 

  4. Bertelli JA, Ghizoni MF. Long thoracic nerve: anatomy and functional assessment. J Bone Joint Surg Inc. 2005;87(5):993–8.

    Google Scholar 

  5. Safran MR. Nerve injury about the shoulder in athletes, part 2. Am J Sports Med. 2004;32(4):1063–76.

    Article  PubMed  Google Scholar 

  6. Kaplan PE. Electrodiagnostic confirmation of long thoracic nerve palsy. J Neurol Neurosurg Psychiatry. 1980;43(1):50–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Wang JF, Dang RS, Wang D, et al. Observation and measurements of long thoracic nerve: a cadaver study and clinical consideration. Surg Radiol Anat. 2008;30:569–73.

    Article  PubMed  Google Scholar 

  8. Aquino SL, Duncan GR, Hayman LA. Nerves of the thorax: atlas of normal and pathologic findings. Radiographics. 2001;21:1275–81.

    Article  CAS  PubMed  Google Scholar 

  9. Gregg JR, Lavosky D, Harty M, et al. Serratus anterior paralysis in the young athlete. J Bone Joint Surg Am. 1979;61:825–32.

    Article  CAS  PubMed  Google Scholar 

  10. Foo CL, Swann M. Isolated paralysis of the serratus anterior. A report of 20 cases. J Bone Joint Surg Br. 1983;65:552–6.

    Article  CAS  PubMed  Google Scholar 

  11. Martinoli C, Gandolfo N, Perez MM, et al. Brachial plexus and nerves about the shoulder. Semin Musculoskelet Radiol. 2010;14(5):523–46.

    Article  PubMed  Google Scholar 

  12. Park HJ, Kim SS, Han CH, et al. The clinical correlation of a new practical MRI method for grading cervical neural foraminal stenosis based on oblique sagittal images. AJR Am J Roentgenol. 2014;203(2):412–7.

    Article  PubMed  Google Scholar 

  13. Baumer P, Kele H, Kretschmer T, et al. Thoracic outlet syndrome in 3T MR neurography-fibrous bands causing discernible lesions of the lower brachial plexus. Eur Radiol. 2014;24(3):756–61.

    Article  CAS  PubMed  Google Scholar 

  14. Demondion X, Herbinet P, Van Sint JS, et al. Imaging assessment of thoracic outlet syndrome. Radiographics. 2006;26(6):1735–50.

    Article  PubMed  Google Scholar 

  15. Kikuchi Y, Nakamura T, Takayama S, Horiuchi Y, Toyama Y. MR imaging in the diagnosis of denervated and reinnervated skeletal muscles: experimental study in rats. Radiology. 2003;229:861–7.

    Article  PubMed  Google Scholar 

  16. Polak JF, Jolesz FA, Adams DF. Magnetic resonance imaging of skeletal muscle. Prolongation of T1 and T2 subsequent to denervation. Investig Radiol. 1988;23:365–9.

    Article  CAS  Google Scholar 

  17. Kim SJ, Hong SH, Jun WS, et al. MR imaging mapping of skeletal muscle denervation in entrapment and compressive neuropathies. Radiographics. 2011;31:319–32.

    Article  PubMed  Google Scholar 

  18. Martin RM, Fish DE. Scapular winging: anatomical review, diagnosis, and treatments. Curr Rev Musculoskelet Med. 2008;1:1–11.

    Article  PubMed  Google Scholar 

  19. Johnson JT, Kendall HO. Isolated paralysis of the serratus anterior muscle. J Bone Joint Surg Am. 1955;37-A:567–74.

    Article  CAS  PubMed  Google Scholar 

  20. Friedenberg SM, Zimprich T, Harper CM. The natural history of long thoracic and spinal accessory neuropathies. Muscle Nerve. 2002;25(4):535–9.

    Article  PubMed  Google Scholar 

  21. Kassardjian CD, O’gorman CM, Sorenson EJ. The risk of iatrogenic pneumothorax after electromyography. Muscle Nerve. 2016;53(4):518–21.

    Article  PubMed  Google Scholar 

  22. Bendszus M, Wessig C, Reiners K, et al. MR imaging in the differential diagnosis of neurogenic foot drop. AJNR Am J Neuroradiol. 2003;24(7):1283–9.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Northwestern University, NMH/Arkes Family Pavilion Suite 800, 676 N. Saint Clair, Chicago, IL, 60611, USA

    Swati Deshmukh

  2. The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA

    Laura M. Fayad & Shivani Ahlawat

  3. Department of Oncology, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA

    Laura M. Fayad

  4. Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA

    Laura M. Fayad

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  1. Swati Deshmukh
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  2. Laura M. Fayad
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Correspondence to Swati Deshmukh.

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Deshmukh, S., Fayad, L.M. & Ahlawat, S. MR neurography (MRN) of the long thoracic nerve: retrospective review of clinical findings and imaging results at our institution over 4 years. Skeletal Radiol 46, 1531–1540 (2017). https://doi.org/10.1007/s00256-017-2737-z

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  • DOI: https://doi.org/10.1007/s00256-017-2737-z

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