Compared to other nerve transfers documented in the literature for over 50 years, the history of nerve transfer from the TDN to the LTN is considerably shorter. The first documented case was from the early 2000s when it was successfully performed on a young patient with idiopathic paralysis of the LTN (Novak and Mackinnon, Ann Thorac Surg 73:1643–1645, 2002). From then on, it began to be used not only for idiopathic causes (Noland et al., Hand (N Y) 13:689–694, 2018; Novak and Mackinnon, Ann Thorac Surg 73:1643–1645, 2002; Ray et al., J Neurosurg 115:858–864, 2011), but it was also demonstrated to be helpful in secondary cases such as high-performance sports activities or iatrogenic injuries (Noland et al., Hand (N Y) 13:689–694, 2018; Post, J Shoulder Elb Surg 4:1–9, 1995). This last subgroup—iatrogenic traumatic injuries—presents the challenge of timely surgical treatment when physiotherapy measures do not provide optimal results for the patient (Atasoy and Majd, J Bone Joint Surg Br 82:813–817, 2000; Berry et al., Can J Neurol Sci 18:337–341, 1991; Gordon et al., Arch Surg 112:264–268, 1977; Mackinnon and Novak, Hand Clin 15:643–666, 1999; Ogino et al., J Hand Surg Br 16:531–536, 1991; Perlmutter and Leffert, J Bone Joint Surg Am 81:377–384, 1999; Weisberger et al., Arch Otolaryngol Head Neck Surg 124:377–380, 1998). The LTN is purely a motor nerve intended to innervate the different portions that constitute the serratus anterior muscle, which inserts in the ventral portion of the scapula, functioning as an anchor point for shoulder mobility, the upper limb, and as an accessory respiratory muscle, raising the ribs during inspiration (Grzybowski and Kaufman, Acta Ophthalmol Scand 85:897–901, 2007; Martin and Fish, Curr Rev Musculoskelet Med 1:1–11, 2008; Segonds et al., Rev Chir Orthop Reparatrice Appar Mot 88:751–759, 2002). Its affectation causes shoulder pain and winged scapula and affects the open kinetic chain consisting of scapular abduction and adduction, impacting shoulder flexion and elevation beyond the horizontal plane (Atasoy and Majd, J Bone Joint Surg Br 82:813–817, 2000; Friedenberg et al., Muscle Nerve 25:535–539, 2002; Mah and Otsuka, J Pediatr Orthop 12:245–247, 1992; Marin, Arch Phys Med Rehabil 79:1226–1230, 1998; Martin and Fish, Curr Rev Musculoskelet Med 1:1–11, 2008; Vastamäki and Kauppila, J Shoulder Elb Surg 2:240–243, 1993; Weisberger et al., Arch Otolaryngol Head Neck Surg 124:377–380, 1998). The critical point in traumatic injuries, especially iatrogenic ones, is that they will require prompt surgical treatment (Berry et al., Can J Neurol Sci 18:337–341, 1991; Friedenberg et al., Muscle Nerve 25:535–539, 2002; Fu and Gordon, J Neurosci 15(5 Pt 2):3886–3895, 1995; Saunders et al., Am J Surg 150:491–494, 1985; Warner and Navarro, Clin Orthop Relat Res 349:139–148, 1998). It is essential to emphasize the significance of establishing a clear and routine schedule of motor physiotherapy to stimulate the tone of each muscle group involved to ensure an excellent functional recovery (Gregg et al., J Bone Joint Surg Am 61:825–832, 1979; Mah and Otsuka, J Pediatr Orthop 12:245–247, 1992; Marin, Arch Phys Med Rehabil 79:1226–1230, 1998; Watson and Schenkman, Phys Ther 75:194–202, 1995; Wiater and Flatow, Clin Orthop Relat Res 368:17–27, 1999).

Thoracodorsal Nerve to Long Thoracic Nerve Transfer

章节
发表日期：

2025年

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Juan Pablo Martinez,
Mariano Socolovsky

摘要

Compared to other nerve transfers documented in the literature for over 50 years, the history of nerve transfer from the TDN to the LTN is considerably shorter. The first documented case was from the early 2000s when it was successfully performed on a young patient with idiopathic paralysis of the LTN (Novak and Mackinnon, Ann Thorac Surg 73:1643–1645, 2002). From then on, it began to be used not only for idiopathic causes (Noland et al., Hand (N Y) 13:689–694, 2018; Novak and Mackinnon, Ann Thorac Surg 73:1643–1645, 2002; Ray et al., J Neurosurg 115:858–864, 2011), but it was also demonstrated to be helpful in secondary cases such as high-performance sports activities or iatrogenic injuries (Noland et al., Hand (N Y) 13:689–694, 2018; Post, J Shoulder Elb Surg 4:1–9, 1995). This last subgroup—iatrogenic traumatic injuries—presents the challenge of timely surgical treatment when physiotherapy measures do not provide optimal results for the patient (Atasoy and Majd, J Bone Joint Surg Br 82:813–817, 2000; Berry et al., Can J Neurol Sci 18:337–341, 1991; Gordon et al., Arch Surg 112:264–268, 1977; Mackinnon and Novak, Hand Clin 15:643–666, 1999; Ogino et al., J Hand Surg Br 16:531–536, 1991; Perlmutter and Leffert, J Bone Joint Surg Am 81:377–384, 1999; Weisberger et al., Arch Otolaryngol Head Neck Surg 124:377–380, 1998). The LTN is purely a motor nerve intended to innervate the different portions that constitute the serratus anterior muscle, which inserts in the ventral portion of the scapula, functioning as an anchor point for shoulder mobility, the upper limb, and as an accessory respiratory muscle, raising the ribs during inspiration (Grzybowski and Kaufman, Acta Ophthalmol Scand 85:897–901, 2007; Martin and Fish, Curr Rev Musculoskelet Med 1:1–11, 2008; Segonds et al., Rev Chir Orthop Reparatrice Appar Mot 88:751–759, 2002). Its affectation causes shoulder pain and winged scapula and affects the open kinetic chain consisting of scapular abduction and adduction, impacting shoulder flexion and elevation beyond the horizontal plane (Atasoy and Majd, J Bone Joint Surg Br 82:813–817, 2000; Friedenberg et al., Muscle Nerve 25:535–539, 2002; Mah and Otsuka, J Pediatr Orthop 12:245–247, 1992; Marin, Arch Phys Med Rehabil 79:1226–1230, 1998; Martin and Fish, Curr Rev Musculoskelet Med 1:1–11, 2008; Vastamäki and Kauppila, J Shoulder Elb Surg 2:240–243, 1993; Weisberger et al., Arch Otolaryngol Head Neck Surg 124:377–380, 1998). The critical point in traumatic injuries, especially iatrogenic ones, is that they will require prompt surgical treatment (Berry et al., Can J Neurol Sci 18:337–341, 1991; Friedenberg et al., Muscle Nerve 25:535–539, 2002; Fu and Gordon, J Neurosci 15(5 Pt 2):3886–3895, 1995; Saunders et al., Am J Surg 150:491–494, 1985; Warner and Navarro, Clin Orthop Relat Res 349:139–148, 1998). It is essential to emphasize the significance of establishing a clear and routine schedule of motor physiotherapy to stimulate the tone of each muscle group involved to ensure an excellent functional recovery (Gregg et al., J Bone Joint Surg Am 61:825–832, 1979; Mah and Otsuka, J Pediatr Orthop 12:245–247, 1992; Marin, Arch Phys Med Rehabil 79:1226–1230, 1998; Watson and Schenkman, Phys Ther 75:194–202, 1995; Wiater and Flatow, Clin Orthop Relat Res 368:17–27, 1999).