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Neuritis
In the shoulder-thoracic region we can distinguish different types of neuritis :
Long thoracic nerve, spinal accessory nerve and suprascapular nerve.
This kind of neuritis has its typical history and clinical image.
(Part I, p40, 44)
Long thoracic - spinal accessory neuritis
In both cases of neuritis, mentioned below, the history is as follows : some weeks of pain (spontaneous onset) and some months of weakness ; a spontaneous recovery (the normal muscle strength returns) occurs in 4-8 months.
Long thoracic neuritis
Limitation of active elevation is the problem. As we have already seen, 180° of elevation consist of three components : 90° glenohumeral abduction, 60° scapular rotation and 30° humerus adduction. The 60° of scapular rotation are at fault. This movement is mainly performed by the serratus anterior muscle, with the help of the trapezius muscle. Gross limitation (-45°) incriminates the main muscle, serratus anterior ; slight limitation (-10°) suggests the auxiliary muscle, trapezius.
A complementary test in long thoracic neuritis is leaning forward with outstretched arms against a wall, which would show a scapula alata/"winging" on one side.
Spinal accessory neuritis
As already mentioned, the limitation is slight (-10°). The complementary test here is, during active approximation of the scapulae, to pull the scapula laterally. Normally this is complet-
ely impossible ; here, because of the weak trapezius, it can be done.
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