A male patient presented with winging of scapula following a trauma. Nerve involved in this lesion is:
The serratus anterior is innervated by the long thoracic nerve. If that's damaged, the muscle can't hold the scapula against the ribcage, causing winging. The trapezius is innervated by the spinal accessory nerve (CN XI), so damage there would cause a different kind of winging, maybe more on the upper part. But the question mentions trauma, so maybe it's a nerve injury from a stab wound or something that could affect the long thoracic nerve.
Wait, the options weren't provided, but the correct answer is supposed to be the long thoracic nerve. Let me confirm. The long thoracic nerve comes from C5-C7. Trauma, especially to the upper back or shoulder area, can damage this nerve. So if the serratus anterior is paralyzed, the scapula can't be pulled forward and medially, leading to winging. The other nerves like the thoracodorsal (for latissimus dorsi) or the dorsal scapular nerve (for rhomboids) don't cause winging when injured. The rhomboids are innervated by the dorsal scapular nerve, so if that's damaged, the scapula might wing at the medial border, but the more common cause is the long thoracic nerve. So the correct answer should be the long thoracic nerve.
**Core Concept**
Winging of the scapula results from dysfunction of muscles that stabilize the scapula against the thoracic wall. The **serratus anterior**, innervated by the **long thoracic nerve**, is critical for protraction and medial rotation of the scapula. Injury to this nerve disrupts scapular stabilization, leading to winging.
**Why the Correct Answer is Right**
The **long thoracic nerve (C5-C7)** innervates the serratus anterior. Trauma, such as a stab wound or iatrogenic injury during surgery, can damage this nerve. When the serratus anterior is paralyzed, the scapula loses its ability to press against the thoracic wall during arm elevation, resulting in prominent winging. This is distinct from trapezius injury (spinal accessory nerve, CN XI), which causes a different pattern of winging.
**Why Each Wrong Option is Incorrect**
**Option A:** *Thoracodorsal nerve* innervates the latissimus dorsi, which is not involved in scapular winging.
**Option B:** *Dorsal scapular nerve* (C5) innervates the rhomboids and levator scapulae; its injury causes medial border winging but is less common than long thoracic nerve palsy.
**Option C:** *Axillary nerve* (C5-C6) innervates the deltoid and teres minor; damage causes shoulder weakness, not winging.
**Clinical Pearl / High-Yield Fact**