During a modified radical mastectomy, the surgeon divides branches of the axillary dissection plane and the patient subsequently develops winging of the scapula. Which nerve has been injured?
- A Thoracodorsal nerve
- B Medial pectoral nerve
- C Long thoracic nerve ✓
- D Intercostobrachial nerve
Correct answer: C. Long thoracic nerve
Explanation
Winging of the scapula following axillary dissection is a classic sign of long thoracic nerve (nerve of Bell, C5-C7) injury, which denervates serratus anterior. The thoracodorsal nerve supplies latissimus dorsi; its injury causes weakness in adduction and internal rotation. The intercostobrachial nerve is sensory and its division causes numbness on the inner arm. Medial pectoral nerve injury reduces pectoralis minor bulk but does not cause winging.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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