Rehabilitation for Neurological Issues

Abstract

Long thoracic nerve palsy (LTNP) and spinal accessory nerve palsy (SANP) can each provide a great challenge for the scapular specialist to rehabilitate due to loss of serratus anterior or trapezius function, respectively. Injury to either nerve may occur in isolation or in combination, due to blunt trauma, penetrating trauma, compression, stretch, traction, viral infection, or iatrogenic trauma [1–16]. Injury to the dorsal scapular nerve, affecting the rhomboid muscles, does occur but will not be directly discussed because of its rarity. Patients presenting with LTNP or SANP may report cervical, thoracic, shoulder, or scapular pain; sensation of upper extremity weakness or instability; and limited shoulder active range of motion (AROM), most notably shoulder flexion in patients with LTNP and abduction in patients with SANP [1, 2, 5–12, 15–18]. However, in the majority of cases, the patients will experience 1–3 weeks of scapular region pain and then only have pain-free weakness. These impairments usually result in some functional limitation of the involved extremity, especially involving lifting or resistance; however, most can function with surprisingly little difficulty for most activities. The severity of symptoms may vary but will often resolve within 24 months through neural regeneration in cases of neuropraxia and axonotmesis [9, 11, 12, 14–18]. In order to appropriately guide patients with LTNP or SANP, the scapular specialist must possess a strong understanding of scapular anatomy, mechanics, and normal muscular activation, as well as the appreciation to complete a thorough scapular evaluation.