%0 Journal Article
%T Serratus muscle stimulation effectively treats notalgia paresthetica caused by long thoracic nerve dysfunction: a case series
%A Charlie K Wang
%A Alpana Gowda
%A Meredith Barad
%A Sean C Mackey
%A Ian R Carroll
%J Journal of Brachial Plexus and Peripheral Nerve Injury
%D 2009
%I Thieme Medical Publishers
%R 10.1186/1749-7221-4-17
%X Notalgia paresthetica (NP) is a poorly-understood condition presenting with pruritus, pain, and paresthesias in an area medial to the scapula and lateral to the thoracic spine. In addition, patients commonly report hyperpigmentation of the skin and other skin abnormalities. It was first described by Astwazaturow in 1934, but both etiology and prevalence of NP are unclear [1,2]. Previous authors have postulated the causes of NP include nerve entrapment of the posterior rami of spinal nerves arising at T2-T6 [3-6], degenerative changes to the corresponding vertebrae [7], and possible involvement of a hereditary component [8]. Cutaneous innervation in this area is provided by the medial cutaneous branches of the dorsal primary rami of the thoracic spinal nerves, which pass through muscles stabilizing the scapula including the rhomboid and trapezius (Figure 1). Immunohistochemical investigations of the symptomatic area have been inconclusive [9-11]. NP has been treated to varying degrees of success with a multitude of palliative approaches directed specifically at the painful or pruritic skin, nerves, and muscle medial to the scapula, including paravertebral nerve blocks [12], cervical epidural steroid injections [13], topical capsaicin [14,15], acupuncture [16], and botulinum toxin type A [17]. Systemic pharmacology used in neuropathic pain more generally has also been directed at NP, including gabapentin [18] and oxcarbazepine [19]. With the exception of a trial of topical capsaicin reporting 30% relief of pruritus [15], no long-acting treatment has shown efficacy in a RCT, and a divergence of explanations for the etiology remains. There is a need to better understand and more effectively treat NP.The long thoracic nerve arises from branches of cervical nerve roots C5-C7 and innervates the serratus anterior muscle. Injury to the long thoracic nerve or its cervical roots leads to dysfunction of the serratus anterior, with consequent scapular winging or loss of normal s
%U http://www.jbppni.com/content/4/1/17