Long thoracic neuropathy resulting from first rib palpation

Injury to the long thoracic nerve and subsequent scapular winging are serious conditions that create significant impairments. This case study describes an entry-level physical therapy student who sustained a long thoracic neuropathy after another student palpated her first rib in a supervised lab that focused on palpation of the upper quarter. The student did not regain full active range of motion until more than four months after the injury, and one year later, she still reports mild, residual shoulder girdle weakness. The long thoracic nerveis unique position, tethered over the first rib, and its superficial location in the supraclavicular fossa make it susceptible to compression injury. Therefore, it is recommended that clinicians use extreme caution when palpating in the supraclavicular fossa. Preferably, clinicians should palpate the first rib along its posterior shaft or anteriorly on the costal cartilage of the first rib, avoiding the supraclavicular fossa all together.