Several weeks after surgical dissection of her left axilla for the removal of lymph nodes for staging and treatment of her breast cancer, a 32-year-old woman was told by her general physician that she had “winging” of her left scapula when she pushed against resistance during her physical examination. She told the physician that she had also experienced difficulty lately in raising her right arm above her head when she was combing her hair. In a subsequent consult visit with her surgeon, she was told that a nerve was accidentally injured during the diagnostic surgical procedure and that this produced her scapular abnormality and inability to raise her arm normally. What was the origin of this nerve?
Several weeks after surgical dissection of her left axilla for the removal of lymph nodes for staging and treatment of her breast cancer, a 32-year-old woman was told by her general physician that she had “winging” of her left scapula when she pushed against resistance during her physical examination. She told the physician that she had also experienced difficulty lately in raising her right arm above her head when she was combing her hair. In a subsequent consult visit with her surgeon, she was told that a nerve was accidentally injured during the diagnostic surgical procedure and that this produced her scapular abnormality and inability to raise her arm normally. What was the origin of this nerve?
π‘ Explanation
**Core Concept**
The brachial plexus is a complex network of nerves that arise from the spinal cord and innervate the upper limb, including the muscles responsible for shoulder movement and arm elevation. The brachial plexus is formed by the ventral rami of C5 to T1 spinal nerves.
**Why the Correct Answer is Right**
The nerve in question is responsible for the motor function of the serratus anterior muscle, which is involved in scapular rotation and elevation, and the supraspinatus muscle, which is involved in arm elevation. The roots of the brachial plexus, specifically C5-C7, give rise to the upper trunk, which in turn gives rise to the suprascapular nerve that innervates the supraspinatus muscle and the long thoracic nerve that innervates the serratus anterior muscle. Injury to these roots can result in weakness or paralysis of these muscles, leading to scapular winging and difficulty raising the arm above the head.
**Why Each Wrong Option is Incorrect**
**Option A:** The upper trunk of the brachial plexus is formed by the roots C5-C6, but it does not directly innervate the serratus anterior muscle. The suprascapular nerve, which is a branch of the upper trunk, innervates the supraspinatus muscle, but not the serratus anterior.
**Option B:** The posterior division of the middle trunk is not directly involved in the innervation of the serratus anterior muscle. The long thoracic nerve, which is responsible for innervating the serratus anterior, arises from the roots of the brachial plexus.
**Option D:** The posterior cord of the brachial plexus is involved in the innervation of the muscles of the posterior arm, but it does not directly innervate the serratus anterior muscle.
**Clinical Pearl / High-Yield Fact**
The brachial plexus is a common site for injury during surgical procedures, particularly those involving the axilla or neck. Recognizing the anatomy of the brachial plexus and its branches is crucial for diagnosing and managing nerve injuries.
**β Correct Answer: C. Roots of the brachial plexus**
β Correct Answer: C. Roots of the brachial plexus
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