Following surgical removal of a firm nodular cancerous swelling in the right breast and exploration of the right axilla, patient was found to have a winged right scapula. This occurred due to injury to which of the following nerve?
## **Core Concept**
The question tests knowledge of the innervation of muscles around the scapula and the clinical presentation of nerve injury. Specifically, it involves understanding the nerves that control scapular movement and the consequences of their injury. The **long thoracic nerve** is a key nerve in this context, responsible for innervating the **serratus anterior muscle**, which plays a crucial role in stabilizing the scapula against the thoracic wall.
## **Why the Correct Answer is Right**
The winged scapula, or **scapular winging**, is a condition where the scapula protrudes and appears to be wing-like due to the loss of its stabilizing muscles. The **serratus anterior muscle** is one of the primary muscles responsible for holding the scapula flat against the back. It is innervated by the **long thoracic nerve**. Injury to this nerve results in weakness of the serratus anterior, leading to scapular winging, particularly noticeable when the patient pushes against resistance. This presentation matches the scenario described.
## **Why Each Wrong Option is Incorrect**
- **Option A:** The **suprascapular nerve** primarily innervates the **supraspinatus** and **infraspinatus muscles**, which are involved in shoulder abduction and external rotation, respectively. Injury to this nerve does not typically cause winging of the scapula.
- **Option B:** The **musculocutaneous nerve** innervates the **biceps brachii**, **brachialis**, and **coracobrachialis**, which are involved in elbow flexion and forearm supination. It does not control scapular movement.
- **Option D:** The **dorsal scapular nerve** innervates the **rhomboids** and **levator scapulae**, which help in elevating and rotating the scapula. While injury to this nerve can affect scapular movement, it typically does not cause the classic winged scapula appearance associated with serratus anterior weakness.
## **Clinical Pearl / High-Yield Fact**
A key clinical pearl is that a winged scapula can result from injury to either the **long thoracic nerve** (serratus anterior weakness) or the **dorsal scapular nerve** (rhomboid weakness), but the presentation and specific muscle weakness patterns can differ. The **long thoracic nerve** injury leads to a more pronounced winging when pushing against resistance.
## **Correct Answer:** C. Long thoracic nerve.