After radical mastectomy there was injury to the long thoracic nerve. The integrity of the nerve can be tested at the bedside by asking the patient to
## **Core Concept**
The long thoracic nerve, also known as the nerve of Bell or external respiratory nerve of Bell, innervates the **serratus anterior muscle**. This muscle plays a crucial role in movements of the scapula, particularly in forward movements and rotations, as well as in stabilizing the scapula against the thoracic wall.
## **Why the Correct Answer is Right**
The correct answer, , involves the action of pushing against resistance. When the serratus anterior muscle contracts, it helps to rotate the scapula, move it forward around the thorax, and also helps to hold the scapula flat against the back. Injury to the long thoracic nerve results in **winging of the scapula**, a condition where the scapula protrudes outward, especially when the patient pushes against resistance. This is because the serratus anterior muscle is weakened or paralyzed, making it difficult for the patient to keep the scapula pressed against the thoracic wall during movements.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option does not specifically relate to a common bedside test for assessing the integrity of the long thoracic nerve or the function of the serratus anterior muscle.
- **Option B:** While lifting the arm above the head can engage the serratus anterior to some extent, it's not the most specific or commonly used maneuver to test the function of this muscle and, by extension, the long thoracic nerve.
- **Option C:** This option does not directly relate to testing the function of the serratus anterior muscle or the long thoracic nerve.
## **Clinical Pearl / High-Yield Fact**
A key clinical test for assessing the long thoracic nerve's integrity is the **push against resistance test**. Patients are asked to push their hands against a wall or the examiner's hand. Normally, the scapula remains flat against the back. However, if there's winging of the scapula (where the medial border of the scapula protrudes outward), it indicates weakness of the serratus anterior muscle, likely due to long thoracic nerve injury.
## **Correct Answer:** . push against resistance.