Iatrogenic injury to the long thoracic nerve: An underestimated cause of morbidity after cardiac surgery

Federico Bizzarri, Giuseppe Davoli, Dimitri Bouklas, Luca Oricchio, Giacomo Frati, Eugenio Neri

Research output: Contribution to journalArticlepeer-review


After heart surgery, complications affecting the brachial plexus have been reported in 2% to 38% of cases. The long thoracic nerve is vulnerable to damage at various levels, due to its long and superficial course. This nerve supplies the serratus anterior muscle, which has an important role in the abduction and elevation of the superior limb; paralysis of the serratus anterior causes "winged scapula," a condition in which the arm cannot be lifted higher than 90° from the side. Unfortunately, the long thoracic nerve can be damaged by a wide variety of traumatic and nontraumatic occurrences, ranging from viral or nonviral disease to improper surgical technique, to the position of the patient during transfer to a hospital bed. Our patient, a 62-year-old man with triple-vessel disease, underwent myocardial revascularization in which right and left internal thoracic arteries and the left radial artery were grafted to the right coronary, descending anterior, and obtuse marginal arteries, respectively. Despite strong recovery and an apparently good postoperative course, the patient sued for damages due to subsequent winging of the left scapula. In this instance, the legal case has less to do with the cause of the lesion (which remains unclear) than with failure to adequately inform the patient of possible complications at the expense of the nervous system. The lesson is that each patient must receive detailed written and oral explanation of the potential benefits and all conceivable risks of a procedure.

Original languageEnglish
Pages (from-to)315-317
Number of pages3
JournalTexas Heart Institute Journal
Issue number4
Publication statusPublished - 2001


  • Brachial plexus/injuries
  • Cardiac surgical procedures/adverse effects
  • Coronary artery bypass/adverse effects
  • Informed consent
  • Malpractice
  • Myocardial revascularization/adverse effects
  • Nerve compression syndromes/etiology
  • Pain, postoperative
  • Peripheral nervous system diseases/etiology
  • Physician-patient relations
  • Scapula/injuries
  • Thoracic nerves/injuries
  • Truth disclosure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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