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Case Report of Nerve Injury in a Naval Pilot

This is a single case report of a 27-year-old male naval fighter pilot with a nerve injury affecting his right shoulder blade. Paralysis of the serratus anterior muscle caused the shoulder blade to stick out, a position called winging of the scapula. The patient also had arm weakness and neck and shoulder pain.

The patient couldn't figure out what caused the problem. He hadn't hurt himself and wasn't doing too much weight lifting. No one in his family had ever had anything like this. There was no history of viral infection. Doctors ruled out a cartilage tear in the shoulder. MRI tests showed he hadn't torn the rotator cuff, either.

A steroid injection to the right shoulder gave him pain relief for about an hour. However, there was no change in his weakness. EMG studies of the muscles showed a nerve palsy of the long thoracic nerve on the right side, causing the weakness of the serratus anterior muscle.

There are many possible causes of long thoracic nerve injury. Heavy packs or a sudden arm injury are the most common causes in the military. In this case, the doctors think pressure injured the pilot's nerve during 18 consecutive takeoffs and landings in his aircraft. Pressure was put on the nerve each time the plane went from zero to 175 knots in three seconds during takeoff, or from 175 to zero in three seconds during landing. This force equals three times the gravitational pull of the earth.

It's likely that more naval pilots have this problem. They may not report it for fear of being grounded. This case could help the military prevent and treat early any future cases of long thoracic nerve injury.

References: LT Michael J. Oakes, DO, USN, et al. Long Thoracic Nerve Palsy in a Fighter Pilot. In The American Journal of Orthopedics. November 2004. Vol. 33. No. 11. Pp. 572-575.

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