title: Relationship of the long thoracic nerve to the scapular tip: an aid to prevention of proximal nerve injury.
abstract: OBJECTIVE
  The objective was to determine the course of the long thoracic nerve relative to the scapula as an aid to the prevention of proximal long thoracic nerve injuries.
  
  
  METHODS
  Eighteen fresh cadavers (7 male, 11 female) were studied. Each was sequentially placed in the transaxillary and posterolateral thoracotomy positions, and the distance of the long thoracic nerve from the scapular tip and anterior scapular border was measured. The measurements were made bilaterally; the mean, standard deviation, and 99% confidence interval were calculated for each position by gender.
  
  
  RESULTS
  Distances from the scapular tip to the long thoracic nerve are listed as mean/outer 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, male 3.1/6.0 cm left, 4.5/5.1 cm right; female 3.2/4.5 cm left, 3.8/5.5 cm right. In all instances, the long thoracic nerve was furthest from the scapula at its tip.
  
  
  CONCLUSIONS
  For patients positioned for a transaxillary thoracotomy, incision sites should be at least 7.5 and 6.0 cm anterior to the scapular tip for male and female patients, respectively. For patients in posterolateral thoracotomy positioning, incisions should be 6.0 and 5.5 cm anterior to the scapular tip for male and female patients, respectively. By using these anatomic guidelines, we believe that the incidence of iatrogenic proximal long thoracic nerve injury can be minimized.
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Salazar
authors.forename: J R
authors.initials: JR
authors.lastname: Doty
authors.forename: E E
authors.initials: EE
authors.lastname: Tseng
authors.forename: P C
authors.initials: PC
authors.lastname: Marin
authors.forename: J A
authors.initials: JA
authors.lastname: Girotto
authors.forename: G S
authors.initials: GS
authors.lastname: Roseborough
authors.forename: S C
authors.initials: SC
authors.lastname: Yang
authors.forename: R F
authors.initials: RF
authors.lastname: Heitmiller
mesh_terms: D000328:Adult; D002102:Cadaver; D005260:Female; D006801:Humans; D007366:Intercostal Muscles / Q000294:innervation / Q000601:surgery; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D011187:Posture; D012540:Scapula / Q000294:innervation*; D012727:Sex Characteristics; D013900:Thoracic Nerves / Q000033:anatomy & histology* / Q000293:injuries*; D013908:Thoracotomy / Q000009:adverse effects*