A 22-year-old woman who recently lost 15 kg presents with difficulty pushing open doors. On examination there is prominence of the medial border of the scapula that worsens on forward elevation of the arm against resistance. Which nerve is injured?

• A Spinal accessory nerve
• B Thoracodorsal nerve
• C Dorsal scapular nerve
• D Long thoracic nerve ✓

Explanation

Winging of the medial scapular border on forward elevation against a wall indicates paralysis of serratus anterior, supplied by the long thoracic nerve (C5, C6, C7). The long thoracic nerve runs superficially on the chest wall in the midaxillary line, making it vulnerable to surgery, trauma and to weight loss where it is stretched over the scalenus medius. Trapezius paralysis from accessory nerve injury instead wings the scapula laterally and worsens on abduction.

Reference: Gray's Anatomy for Students, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.