Question

Following surgical removal of a firm nodular cancer swelling in the right breast and exploration of the right axilla, on examination the patient was found to have a winged scapula. This occurred due to injury to the

• A. Subscapular muscle
• B. Coracoid process of scapula
• C. Long thoracic nerve
• D. Circumflex scapular artery

Hint:

Winged scapula after axillary surgery points to serratus anterior palsy from long thoracic nerve injury.

Answer 1

The Correct Option is C

Step 1: Understanding the Question:
A woman had a breast cancer removed along with clearing of the right axilla. After surgery her scapula sticks out at the back, a sign called winging of the scapula. We need to find which structure got hurt during the axillary surgery to cause this.

Step 2: Key Concept:
Winging of the scapula happens when the serratus anterior muscle stops working. This muscle holds the medial border of the scapula flat against the rib cage. Serratus anterior gets its nerve supply from the long thoracic nerve, also called the nerve of Bell. This nerve comes from roots C5, C6 and C7 of the brachial plexus and runs down along the outer chest wall, right over the surface of serratus anterior, close to the lateral wall of the axilla.

Step 3: Detailed Explanation:
Because the long thoracic nerve lies superficially on the chest wall inside the axilla, it is one of the structures most at risk during axillary lymph node clearance for breast cancer. If it is cut or stretched, serratus anterior becomes weak or paralysed. The medial border and inferior angle of the scapula then lift away from the chest wall, especially when the arm pushes against resistance, giving the classic winged scapula.
The subscapular muscle is supplied by the upper and lower subscapular nerves, and its injury weakens internal rotation of the shoulder, not winging. The coracoid process is a bony projection, not a nerve or muscle, so damaging it does not explain a nerve palsy. The circumflex scapular artery is a blood vessel that runs through the triangular space; injuring it can cause bleeding or reduced blood flow to nearby muscles but does not paralyse serratus anterior.

Step 4: Final Answer:
The winged scapula after axillary clearance points to injury of the long thoracic nerve, which is option (3).