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Surgical decompression
and neurolysis appears to be an effective and rational
treatment modality in specific instances where supraclavicular
injury to the long thoracic nerve is identified. Risk factors
for supraclavicular nerve injury include a history of vigorous
athletic maneuvers with the affected extremity, lifting of
heavy weights, and direct external pressure on the area as
in deep massage.
Injury to
the upper trunk of the brachial plexus is also associated
with the proposed stretch or compression mechanisms causative
of the injury. In terms of upper trunk pathology, the shoulder
examination is somewhat unreliable, as the long- standing
scapular instability will secondarily affect deltoid and spinati
strength. However, biceps weakness to BMG 3 or 4 was invariably
found in the current patient group, and this is direct evidence
of upper trunk injury.
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