8619 - Long thoracic nerve-Neuritis

DBQ: Link to Index of DBQ/Exams by Disability for DC 8619 

Definition

Neuritis refers to an inflammation of a nerve accompanied by pain and tenderness, anesthesia and paresthesia, paralysis, wasting, and disappearance of the reflexes. This code refers to the long thoracic nerve, a motor nerve that arises from the fifth, sixth, and seventh cervical roots of the brachial plexus. (See Diagnostic Code: 8610 Upper radicular group-Neuritis, and Diagnostic Code: 8611 Middle radicular group-Neuritis.) It innervates the serratus anterior muscle, which draws the scapula forward, and rotates it to raise the shoulder in abduction of the arm.

Etiology

Neuritis of peripheral nerves may be caused by damage to nerve fibers, cell body, or myelin sheath. Injury to the long thoracic nerve most commonly occurs in men who do heavy labor. Continuous muscular effort with the arm extended, or carrying heavy sharp-cornered objects on the shoulder may result in nerve injury and neuritis.

Signs & Symptoms

Manifestations resulting form both acute or chronic conditions include: weakness when the arm is elevated above the horizontal plane, and winging of the scapula (scapula is elevated and visible) when the arm is fully abducted or elevated anteriorly. When the arm is at the side, winging is not visible.

Tests

Diagnostic measures may include a complete history, and physical and neurological examinations. Electrophysiologic studies, may be used, to distinguish between spinal nerve root causes and long thoracic nerve dysfunction when there are neurogenic changes in the serratus anterior muscle. Other studies may include: nerve conduction tests; electromyography (EMG); computed tomography (CT) scan; magnetic resonance imaging (MRI); muscle-strength testing; deep tendon reflexes (DTR); sensory testing; and x-ray.

Treatment

Satisfactory results are usually obtained with conservative treatment. Such treatment may include: physical therapy; splints; anti-inflammatory and analgesic medications; and transcutaneous electrical nerve stimulation (TENS). Surgical intervention to repair a severed nerve is a possibility.

Residuals

Residuals are related to the degree of injury to the nerve. If either no axons, or a few axons are lost, recovery is complete within a few weeks. If the axon loss is severe, then nerve regeneration and return of function is slow. Recovery may take several months, and could range from return to complete function to permanent dysfunction. Alteration in activities of daily living (ADL) and employment may require counseling.

Special Considerations

  • If the Veteran is a former prisoner of war and was interned or detained for not less than 30 days, this disease shall be service connected if manifest to a degree of disability of 10% or more at any time after discharge or release from active military, naval, or air service even though there is no record of such disease during service, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR 3.309(c) Disease subject to presumptive service connection].

  • If the Veteran was exposed to an herbicide agent during active military, naval, or air service, this disease shall be service-connected if the requirements of 38 CFR 3.307(a)(6) are met even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 CFR 3.309(e). Disease subject to presumptive service connection.

  • Consider potential entitlement to special monthly compensation for loss of use of hand or foot when assigning the higher evaluations under particular Diagnostic Codes (e.g., Diagnostic Code 8510 through 8515, 8520, and 8521).

  • This disability shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied.  38 CFR 3.309(a)

Notes

  • Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete, paralysis. See nerve involved for diagnostic code number and rating. The maximum rating which may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis.  38 CFR 4.123 Neuritis, cranial or peripheral.

  • With the exceptions noted, disability from the following diseases and their residuals may be rated from 10 percent to 100 percent in proportion to the impairment of motor, sensory, or mental function. Consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc., referring to the appropriate bodily system of the schedule. With partial loss of use of one or more extremities from neurological lesions, rate by comparison with the mild, moderate, severe, or complete paralysis of peripheral nerves] 38 CFR 4.124a Schedule of ratings—neurological conditions and convulsive disorders.