A 30-year-old woman develops a prominent winging of the right scapula after an attack of severe influenza with coughing. On examination the scapula displaces laterally when she pushes against a wall, and overhead abduction is weak. Which nerve is injured?

• A Long thoracic nerve ✓
• B Dorsal scapular nerve
• C Spinal part of the accessory nerve
• D Suprascapular nerve

Explanation

Winging that worsens on forward pushing against a wall indicates serratus anterior paralysis from long thoracic nerve injury (A5, A6, A7), which runs on the superficial surface of the muscle and is vulnerable to viral illness, traction, and mastectomy. Serratus anterior holds the scapula against the chest wall during protraction and abduction. Accessory nerve injury also causes winging but the scapula displaces medially and downward, with weakness mainly in shrugging and trapezius wasting.

Reference: Gray's Anatomy for Students / standard orthopaedic texts, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.