After mastectomy, patient is NOT able to extend, adduct and internally rotate the arm. Nerve supply to which of the following muscles is damaged:-
## **Core Concept**
The question tests knowledge of the innervation and function of muscles involved in arm movement, specifically those affected by mastectomy. Mastectomy can lead to damage to nerves supplying muscles of the shoulder and upper limb. The movements mentioned - extension, adduction, and internal rotation of the arm - are primarily associated with specific muscles innervated by the posterior cord of the brachial plexus.
## **Why the Correct Answer is Right**
The muscles primarily responsible for the extension, adduction, and internal rotation of the arm are the latissimus dorsi and teres major. Among these, the latissimus dorsi is particularly known for its role in extension, adduction, and internal rotation of the shoulder joint. The latissimus dorsi muscle is innervated by the **thoracodorsal nerve**, which is a branch of the posterior cord of the brachial plexus (C6-C8). Damage to this nerve during mastectomy would result in the inability to perform these movements.
## **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. Damage to this nerve would not primarily affect extension, adduction, and internal rotation.
- **Option B:** The musculocutaneous nerve innervates the biceps brachii, brachialis, and coracobrachialis, which are involved in elbow flexion and forearm supination, not the movements mentioned.
- **Option D:** The axillary nerve innervates the deltoid and teres minor muscles. While it does contribute to arm abduction (deltoid) and shoulder joint stability, its damage would not primarily result in the inability to extend, adduct, and internally rotate the arm.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that the **thoracodorsal nerve** is particularly at risk during surgical procedures like mastectomy due to its proximity to the surgical site. Damage to this nerve can lead to weakness or paralysis of the latissimus dorsi muscle, manifesting as difficulty with extension, adduction, and internal rotation of the arm.
## **Correct Answer:** . **Thoracodorsal nerve**