Surgical Tutorial – Thoracodorsal to Long Thoracic Nerve Transfer. Patients with long thoracic nerve injuries exhibit scapular winging and sever shoulder dificents that include the inability to forward flex the shoulder past 90° of range of motion. Thoracodorsal to long thoracic nerve transfer utilizes a distal posterior branch of the thoracodorsal nerve to reinnervate the distal half of the long thoracic nerve. This operation occurs in the lateral aspect of the thorax. The distal half of the long thoracic nerve innervates the distal half of the serratus anterior, which inserts to the inferior angle of the scapula and provides scapular upward rotation during shoulder movements. A second procedure is used to reinnervate the proximal half of the serratus anterior. Together, the proximal and distal nerve transfers are known as the double-level nerve transfer for long thoracic nerve function.