IATROGENIC SERRATUS ANTERIOR PARALYSIS - LONG-TERM OUTCOME IN 26 PATIENTS

Study objective: To evaluate the treatment, extent of recovery, and re sidual disability in 26 iatrogenic cases of serratus paralysis. Patien ts and study design: Seventeen cases of serratus anterior paralysis ha d occurred following a local invasive procedure along the course of th e long thoracic nerve, including seven first-rib resections, four mast ectomies with axillary dissection, two scalenotomies, two surgical tre atments of spontaneous pneumothorax, and two infraclavicular plexus an esthesia. Eight cases of paralysis had occurred after general anesthes ia for patients who had undergone surgery for diverse clinical reasons , One case of paralysis occurred after spinal anesthesia, The length o f sick leave, treatment with a shoulder brace, amount of physical ther apy, long-term symptoms, and residual disability were evaluated from t he medical records and from the questionnaire sent to the patients on average 6 years (range, 2 to 11 years) after the onset of the paralysi s. Results: Despite comprehensive and lengthy treatment, all but one h ad residual symptoms, as well as limitations in the use of the affecte d limb, Twenty-one (81%) of the patients could not lift or pull heavy objects, 15 (58%) could not play sports, such as tennis or golf, and 1 4 (54%) found it impossible to work with hands above shoulder level. C onclusion: Serratus anterior paralysis, following anesthesia or local invasive procedures on the anterolateral aspect of the thorax, may cau se considerable and long-term dysfunction of the shoulder girdle and a ffect the function of the whole upper limb.