hi everyone,
The long thoracic nerve (LTN) is a nerve which innervates the serratus anterior muscle. The serratus anterior muscle is the muscle which helps stabilize the scapula when you use your arm. The higher or further away from your body that you move your arm, the more the serratus anterior is brought into play. The serratus anterior in combination with the pectoralis minor move the scapula around the rib cage when you reach forward. The serratus anterior is said to be used in deep inspiration. Complete severing of the nerve will cause winging of the scapula.. It usually has 3 roots in the cervical spine. The two roots from c5,c6 pierce the scalenus medius and then join with the c7 root as it travels toward the serratus anterior muscle. Compromise of the nerve is thought to occur in a few different locations along its path. Spasm to the scalenus medius muscle, bowstringing across a facial band as the scapula migrates upward, angulation as it crosses the second rib and the nerve might be compressed between the coracoid process and the second rib. (source: Mapping the course of the long thoracic nerve http://www.neuroanatomy.org/2004/002_007.pdf ) the experts don’t know why but in the majority of cases people suffering from LTN palsy recover within 6 months to 2 years. That is of course if they are correctly diagnosed and they are not put on work hardening courses or other strengthening courses which do not allow recovery.
When I was at my worst, a pt said that I was chest breathing, this was not significant to me because I was feeling so bad that I was glad that I was breathing at all. Now I am taking medication for my breathing problem, the difference between chest breathing and abdominal breathing is obvious. To allow people who have not had the problem or have become so used to chest breathing to understand chest breathing, it is like putting your arms at 45 degrees above your head so that your chest opens up as wide as possible and then calling this your “at rest chest position” and then try to breathe in further still. To put it another way if you can imagine the normal cycle of deep breathing goes from -10 to 0 to +10, and normal sedentary breathing was -2 to 0 to +2, then chest breathing +2 to +4 to +6

As I have remarked before investigations into hypertension showed that I had hyperinflated lung fields, and pulmonary function tests (deep breathing tests) caused soreness to the area between my neck and the scapula on my affected side and as a consequence I lost scapula stability, my arm felt heavy and then there were symptoms in my hand. The medication (pulmicort) reversed this condition. Made my ribcage softer, my bed felt as though it had a new mattress. Exercises which had left me physically distressed previously, were now a doddle.
The medical book Grays Anatomy (1976) says regarding the serratus anterior “It is claimed that electromyography has finally disproved the popular view that the serratus anterior is an accessory inspiratory muscle; but the foot note reference cited , (100) refers to work on dogs , whereas an electromyographic study on man, (101) ignores the effect of fixing the scapula by holding onto , say, a bed rail, railing, and so on as asthmatics and athletes may be seen to do! This problem is not yet resolved.
This is an awkward quote, essentially what they are saying is they have proved that the serratus anterior is not used to assist breathing but if this is the case why then do asthmatics and athletes who have just run at their limit tend to hold onto a rail to assist breathing by stabilizing their scapula. maybe it is the other way round. Maybe deep chest breathing causes compromise to the LTN which would weaken the serratus anterior therefore asthmatics and athletes hold rails so that they can relax their scapula against their chest wall and therefore not compromise the LTN as it travels under the scapula.
If you do an internet search of breathing + TOS or Chronic fatigue syndrome or T4 syndrome or RSI or RSD or Gastro oesophageal reflux or OOS or WRULD or ………. You will find that so many of these conditions require that the sufferer practice abdominal breathing. I can only assume that this is in response to the sufferer being a chest breather. What if the chest breathing is as a result of a neurological consequence of their condition. It seems strange to me that they hand out bucket loads of drugs for all manner of symptoms but none for the breathing problem.
Regards towelhorse