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J Brachial Plex Peripher Nerve Inj 2009; 04(01): e127-e132
DOI: 10.1186/1749-7221-4-17
Case report
Wang et al; licensee BioMed Central Ltd.

Serratus muscle stimulation effectively treats notalgia paresthetica caused by long thoracic nerve dysfunction: a case series[*]

Charlie K Wang
1   Department of Anesthesia, Stanford University School of Medicine, Stanford Systems Neuroscience and Pain Lab, Palo Alto, CA, USA
,
Alpana Gowda
2   Department of Anesthesia, Division of Pain Management, Stanford University School of Medicine, Stanford Pain Management Clinic, Redwood City, CA, USA
,
Meredith Barad
1   Department of Anesthesia, Stanford University School of Medicine, Stanford Systems Neuroscience and Pain Lab, Palo Alto, CA, USA
2   Department of Anesthesia, Division of Pain Management, Stanford University School of Medicine, Stanford Pain Management Clinic, Redwood City, CA, USA
,
Sean C Mackey
1   Department of Anesthesia, Stanford University School of Medicine, Stanford Systems Neuroscience and Pain Lab, Palo Alto, CA, USA
2   Department of Anesthesia, Division of Pain Management, Stanford University School of Medicine, Stanford Pain Management Clinic, Redwood City, CA, USA
,
Ian R Carroll
1   Department of Anesthesia, Stanford University School of Medicine, Stanford Systems Neuroscience and Pain Lab, Palo Alto, CA, USA
2   Department of Anesthesia, Division of Pain Management, Stanford University School of Medicine, Stanford Pain Management Clinic, Redwood City, CA, USA
› Author Affiliations
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Publication History

07 August 2009

22 September 2009

Publication Date:
18 September 2014 (online)

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Abstract

Currently, notalgia paresthetica (NP) is a poorly-understood condition diagnosed on the basis of pruritus, pain, or both, in the area medial to the scapula and lateral to the thoracic spine. It has been proposed that NP is caused by degenerative changes to the T2-T6 vertebrae, genetic disposition, or nerve entrapment of the posterior rami of spinal nerves arising at T2-T6. Despite considerable research, the etiology of NP remains unclear, and a multitude of different treatment modalities have correspondingly met with varying degrees of success. Here we demonstrate that NP can be caused by long thoracic nerve injury leading to serratus anterior dysfunction, and that electrical muscle stimulation (EMS) of the serratus anterior can successfully and conservatively treat NP. In four cases of NP with known injury to the long thoracic nerve we performed transcutaneous EMS to the serratus anterior in an area far lateral to the site of pain and pruritus, resulting in significant and rapid pain relief. These findings are the first to identify long thoracic nerve injury as a cause for notalgia paresthetica and electrical muscle stimulation of the serratus anterior as a possible treatment, and we discuss the implications of these findings on better diagnosing and treating notalgia paresthetica.

*This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.