Relationship of the long thoracic nerve to the scapular tip: An aid to prevention of proximal nerve injury

Objective: The objective was to determine the course of the long thoracic n erve relative to the scapula as an aid to the prevention of proximal long t horacic nerve injuries. Methods: Eighteen fresh cadavers (7 male, 11 female ) were studied. Each was sequentially placed in the transaxillary and poste rolateral thoracotomy positions, and the distance of the long thoracic nerv e from the scapular tip and anterior scapular border was measured. The meas urements were made bilaterally; the mean, standard deviation, and 99% confi dence interval mere calculated for each position by gender. Results: Distan ces from the scapular tip to the long thoracic nerve are listed as mean/out er range: transaxillary thoracotomy, male 4.9/7.0 cm left, 5.2/7.5 cm right ; female 4.3/5.0 cm left, 4.7/6.0 cm right; posterolateral thoracotomy, mal e 3.1/6.0 cm left, 4.5/5.1 cm right; female 3.2/4.5 cm left, 3.8/5.5 cm rig ht. In all instances, the long thoracic nerve was furthest from the scapula at its tip. Conclusion: For patients positioned for a transaxillary thorac otomy, incision sites should be at least 7.5 and 6.0 cm anterior to the sca pular tip for male and female patients, respectively, For patients in poste rolateral thoracotomy positioning, incisions should be 6.0 and 5.5 cm anter ior to the scapular tip for male and female patients, respectively, By usin g these anatomic guidelines, me believe that the incidence of iatrogenic pr oximal long thoracic nerve injury can be minimized.