Long thoracic neuropathy
ICD-10 G58.9 ICD-11 8C12&XA0A05

What is the first-line treatment for Long thoracic neuropathy?

Long thoracic neuropathy presents with scapular winging and associated shoulder dysfunction. Initial management focuses on conservative care — maintaining shoulder motion, controlling pain, and supporting spontaneous nerve recovery before any further intervention is considered.

Treatment Approach

First-line care centres on an extended period of conservative management. Physical therapy addressing scapular and shoulder function is a key component, combined with pain management and structured activity modification. The complete protocol specifies the full programme, progression criteria, and when escalation becomes appropriate.

Full regimen details — including programme sequence, activity guidance, and decision points — are available in the structured protocol below.

Clinical goal Spontaneous resolution of scapular winging, expected within 9–12 months from the onset of winging in patients who respond to conservative management.
Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.jhsg.2022.11.006

As a result, most descriptions of winging management focus on the maintenance of shoulder motion, pain control, and activity modification with avoidance of precipitating factors.

Physical therapy is generally prescribed for range of motion, scapular stabilization, rotator cuff stretching, and periscapular muscle strengthening.

Therefore, we recommend an initial period of conservative management for 9–12 months before considering surgery.

In our practice, we have observed that most patients who recover spontaneously do so in 9–12 months from the onset of winging.

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