Hi everyone,

I saw a thirty year old lady last week who suffered a fall from her bicycle 2 months ago, whereby the wheels jammed and she fell onto her left hand side.

She complains of a left 'dead arm' and slight ache along the superior border of her left scapula. The dead arm is most noticable when driving and she tends to hold onto the bottom of the steering wheel. When she lies on her left side the arm goes numb straight away. She didn't have any other specific aggs as she tends not to use the arm so much.

On examination, she has a slight winging of the left scapula which becomes more noticeable on eccentric activity. Actively she cannot abduct/flex the arm for the last 20 degrees or so, but this can be gained passively by bringing the scapula into abduction and medial rotation. She had reduced sensation in dermatomes C5-T1 but full power (except in serratus anterior, obviously). ULTT's were negative. I have not yet examined the cervical or thoracic spines.

She has had UL and neck X rays which were fine. An orthopaedic surgeon thinks she may have a problem with the long thoracic nerve and has referred her for an EMG. Her osteopath hasn't helped either.

I'm wondering just how the long thoracic nerve could have been isolated in the mechanism of injury (if this is the diagnosis) without damage to other parts of the brachial plexus? Has anyone had a similar experience or can offer any advice at all? I really don't know where to go with her!

Many thanks in advance.

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