Long Thoracic Nerve, Gross Anatomy

Description

Arising from the anterior rami of C5 to C7 at the root level of the brachial plexus, the long thoracic nerve descends inferiorly and slightly posterior along the lateral thoracic wall, tracking over the outer surfaces of the upper ribs. A left lateral perspective brings the thoracic vertebrae and posterior rib articulations into alignment, with the scapula positioned lateral to the rib cage and acting as a key surface landmark for the nerve’s course. Its trajectory runs medial to the scapular border as it approaches the serratus anterior slips, which lie superficial to the ribs and deep to the scapula during protraction. Long course. Exposed. That extended rib-hugging path is exactly why this nerve is a repeat offender in iatrogenic and traction injuries. Axillary lymph node dissection, mastectomy, chest tube placement along the midaxillary line, and blunt lateral thoracic trauma can all compromise the long thoracic nerve, producing serratus anterior palsy and the classic medial scapular winging that worsens with resisted forward flexion or a wall push-up. The relationship to the ribs matters for teaching, because many learners confuse it with the thoracodorsal nerve, which travels with the subscapular system and targets latissimus dorsi, not the serratus anterior. Use this artwork to anchor lectures on brachial plexus branch anatomy, scapulothoracic mechanics, and surface anatomy of the lateral chest wall in gross anatomy, physical therapy, and sports medicine curricula. It also supports surgical education materials for breast, thoracic, and axillary procedures where long thoracic nerve identification and protection are emphasized. Anatomical accuracy verified by SciePro's Medical Advisory Board.