[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anatomy](https://durgical.com/en/anatomy/) › [Upper limb](https://durgical.com/en/anatomy/region/upper-limb/) › Long thoracic nerve [Nervous system](https://durgical.com/en/anatomy/system/nervous-system/) · [Upper limb](https://durgical.com/en/anatomy/region/upper-limb/) # Long thoracic nerve The long thoracic nerve runs down the side of the chest wall; it moves the serratus anterior, and damage makes the shoulder blade stick out (winging). [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=upper_limb&select=long_thoracic_nerve&side=r) Opens in the Durgical app, no sign-up needed. ## What it is A long nerve down the side of the chest to serratus anterior; injury (heavy backpacks, sports, surgery) causes a winged scapula. ## What it does Powers serratus anterior; damage makes the shoulder blade stick out (winging). ## Key points - Serratus anterior palsy gives medial winging: the medial border and inferior angle of the [scapula](https://durgical.com/en/anatomy/scapula/) lift off the chest wall, best seen when pushing against a wall - Runs down on the outer surface of serratus anterior, on the medial wall of the axilla, where it is exposed in axillary lymph node dissection and mastectomy - [Trapezius](https://durgical.com/en/anatomy/trapezius-muscle/) palsy (spinal [accessory nerve](https://durgical.com/en/anatomy/accessory-nerve/)) gives lateral winging with a drooping shoulder instead; rhomboid palsy ([dorsal scapular nerve](https://durgical.com/en/anatomy/dorsal-scapular-nerve/)) gives only mild winging ## Key facts **Roots** C5–C7 roots (some texts: C6–C7) **Moves** Serratus anterior (injury = winged scapula) **Feeling from** None ## Relations **Course** The C5 and C6 roots pierce the middle scalene and are joined by C7; the nerve descends behind the [brachial plexus](https://durgical.com/en/anatomy/roots-of-brachial-plexus/) and the first part of the [axillary artery](https://durgical.com/en/anatomy/axillary-artery/), crosses the [first rib](https://durgical.com/en/anatomy/first-rib/) into the axilla and runs down the outer surface of [serratus anterior](https://durgical.com/en/anatomy/serratus-anterior/) near the midaxillary line, supplying each digitation **Deep** Serratus anterior, on whose surface it lies **In front** The [lateral thoracic artery](https://durgical.com/en/anatomy/lateral-thoracic-artery/), which runs down in front of it **Behind** The [thoracodorsal nerve](https://durgical.com/en/anatomy/thoracodorsal-nerve/) and vessels on the posterior wall of the axilla **Superficial** Axillary fat and lymph nodes and the [skin](https://durgical.com/en/anatomy/skin/) of the lateral [chest](https://durgical.com/en/anatomy/region/chest/) wall ## How to find it Not palpable. In axillary surgery it is identified on the chest wall under a thin fascial layer over serratus anterior, near the midaxillary line, in front of the thoracodorsal bundle; both nerves are preserved. ## Examination - Wall push-up: pushing against a wall with straight arms makes the medial border and inferior angle of the scapula lift off the chest; positive = serratus anterior weakness - Forward elevation of the arm is limited and painful; pressing the scapula against the [ribs](https://durgical.com/en/anatomy/ribs/) by hand (scapular assistance) improves it ## On imaging Not seen on routine imaging; the diagnosis is clinical (medial winging when pushing on a wall) and confirmed by electromyography of serratus anterior. MRI of the chest wall can show oedema of serratus anterior early and fatty atrophy later. MRI of the cervical [spine](https://durgical.com/en/anatomy/region/spine/) or brachial plexus excludes a root or plexus lesion, and ultrasound can follow the nerve on the serratus in the mid-axillary line. ## Common problems - Winged scapula: the inner edge of the shoulder blade lifts off the ribs when the long thoracic nerve is injured. - Weakness makes overhead reaching and pushing hard and can strain the shoulder. ## How it is diagnosed Wall push-up test shows the winging. EMG checks the long thoracic nerve. ## Treatment - Physical therapy; most nerve stretch injuries recover over months. - Muscle or tendon transfer surgery if the nerve does not recover. ## Clinical notes - Injured in axillary lymph node dissection, mastectomy, first rib resection, chest drain insertion and lateral thoracotomy - Non-surgical causes: heavy loads on the shoulder strap (rucksack palsy), repeated overhead sport and neuralgic amyotrophy - Most stretch palsies recover slowly over months; persistent winging may be treated by transferring the sternal head of [pectoralis major](https://durgical.com/en/anatomy/pectoralis-major-muscle/) to the scapula ## Anatomical variants - A small C8 contribution is reported in about one person in ten, and the C7 root may be missing ## Development Serratus anterior is not a body-wall muscle like the intercostals: it develops with the limb musculature and spreads onto the chest wall, which is why its nerve comes from the plexus roots (C5–C7) and not from [intercostal nerves](https://durgical.com/en/anatomy/intercostal-nerves/). ## Memory aid 'C5, 6, 7, wings of heaven': the long thoracic nerve (C5–C7) keeps the scapula on the chest; injury gives a winged scapula. 'SALT': Serratus Anterior, Long Thoracic. ## Related conditions - [Winged scapula](https://durgical.com/en/conditions/winged-scapula/) ## Test yourself Think of the answer, then tap the question to see it. ## Which muscle does the long thoracic nerve supply, and which roots form it? Serratus anterior; C5–C7 roots. ## What scapular sign follows long thoracic nerve palsy, and how is it shown? Medial winging: the medial border and inferior angle lift off the chest wall, best seen with a wall push-up. ## How does winging from spinal accessory nerve palsy differ from long thoracic nerve palsy? Trapezius palsy gives lateral winging with a drooping shoulder; serratus anterior palsy gives medial winging. ## In which operations is the long thoracic nerve at risk? Axillary lymph node dissection, mastectomy, first rib resection, chest drain insertion and lateral thoracotomy; it lies on serratus anterior on the medial axillary wall. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/anatomy/long-thoracic-nerve/) Educational information, not medical advice. For any symptom, see a health professional. ## Its names **Official Latin (TA2)** nervus thoracicus longus TA2 6410 **Official Spanish (DeCS)** Nervio torácico largo **English (TA2)** Long thoracic nerve ## Related - [Serratus anterior](https://durgical.com/en/anatomy/serratus-anterior/) - [Lateral thoracic artery](https://durgical.com/en/anatomy/lateral-thoracic-artery/) Sources: Terminologia Anatomica (TA2); [Anatomy, Thorax, Long Thoracic Nerve](https://www.ncbi.nlm.nih.gov/books/NBK535396/); Anatomy of the Human Body (20th ed.): Development of the Muscles (Lea & Febiger (Gray's Anatomy, 1918), 1918) · adapted, Public domain. ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/anatomy/long-thoracic-nerve/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/long-thoracic-nerve/