Revista de Medicina Desportiva (English) January 2019 | Page 25

long path that the nerve is vulnera-
ble to different kinds of mechanical
injuries. 7,20  The majority of the trau-
matic injuries of the long thoracic
nerve are neuropraxic caused by
direct traumatic contusion, due to
its subcutaneous localization on
the exit from the pectoral muscle
at the level of the 4 th or 5 th rib, or by
repeated movements of the athle-
tes, generally because of a traction
mechanism of the nerve. 20 Although
the association between trauma
and paralysis of the anterior serra-
tus muscle is established, there is
no consensus how trauma injuries
de long thoracic nerve. 7 Initially, it
was proposed a sudden or repeated
traction of the long thoracic nerve
responsible for the paralysis of the
anterior serratus muscle, however,
and taking into consideration the
length of the nerve, it advocates
that it must have a greater capacity
to elongate, supported on the fact
that injuries of the brachial plexus
are not definitely associated with
injuries of the long thoracic nerve. 4,13  
The injury may occur when the
nerve is out of the fascial sheath,
either by traction or as an arch
reflex. 21
According to the literature, there
are a lot of sports with reported
cases of paralysis of the long thora-
cic nerve, including archery, tennis
and basketball. 2 There is only one
study about the incidence of injuries
on futsal, referring that it is a sport
with a high index of injuries, of the
same type and localization of foot-
ball (soccer). 22 In the study UEFA Elite
Club Injury Study Report 2016/17, the
injuries of the cervical area and
scapular girdle in football corres-
pond to less than 1.4% of the total. 23
The occurrence of direct trauma to
cervical and scapular girdle, with or
without impact, might occur on the
futsal, and in the present case the
paralysis of the anterior serratus
muscle can be caused by a direct
traumatism, although it is difficult
to find out the exact mechanism of
injury.
The non-traumatic injuries include
compression on several anatomic
points, virus infections, allergic reac-
tions to medicines, exposure to envi-
ronmental toxics, C7 radiculopathy
and coarctation of the aorta. 7,13  The
iatrogenic injury of the long thoracic
nerve is described as a consequence
of chiropractic procedures, the use
of axillar cans, surgeries and after
general anesthesia. 7
The clinical presentation of the
paralysis of the anterior serratus
muscle is typically characterized by
pain on the shoulder, described as
a burner, with possible irradiation
to the upper limb and scapula, with
spontaneous resolution, associa-
ted to weakness / fatigue on the
shoulder and with WS 4,7,9,13,24 , like
the case described in this paper. On
physical exam, medial WS is gene-
rally evident on rest, with medial
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Revista de Medicina Desportiva informa january 2019 · 23