Anatomical entrapment of the dorsal scapular and long thoracic nerves, secondary to brachial plexus piercing variation.

Abstract

Circumscapular pain is a frequent complaint in clinical practice. The dorsal scapular and long thoracic nerves course through the neck, where they may become entrapped between or within adjacent scalene muscles. Additionally, a high frequency of brachial plexus "piercing" variants have recently been documented, and it is unclear how they influence branching patterns distally along the brachial plexus. In the project reported here we strived to identify and quantify variations in dorsal scapular nerve and long thoracic nerve secondary to brachial plexus piercing variation. Ninety brachial plexuses from human cadavers (45 female/45male) were evaluated to identify nerve branching patterns, specifically piercing versus non-piercing variants in the brachial plexus roots and nerves. Anatomical entrapment of the dorsal scapular nerve and long thoracic nerve was found in high frequencies (60.8% and 44.6%, respectively). Anomalous brachial plexus piercing variants were associated with higher frequencies of distal nerve branches also coursing through the scalene musculature, and there was a statistically significant correlation between brachial plexus and long thoracic nerve piercings (p = 0.027). Anatomical entrapment of nerves within scalene musculature is common and may be causative factors for idiopathic circumscapular pain, dorsalgia, and dysfunction of scapulohumeral rhythm. This study revealed a link between anatomical arrangement of the brachial plexus and occurrence of long thoracic nerve entrapment, which may lead to a series of cascading neurologic effects in which affected individuals may suffer from increased incidence of thoracic outlet syndrome and long thoracic nerve entrapment resulting in additional symptoms of interscapular pain and compromised shoulder mobility.