A prospective study of shoulder disability resulting from radical and modified neck dissections

Abstract

A prospective longitudinal study of shoulder function after 103 neck dissections involving either preservation or sacrifice of the spinal accessory nerve is presented. The postoperative evolution and course of trapezius muscle denervation and resultant shoulder dysfunction were objectively determined for both radical and modified nerve sparing neck dissections. All patients were enrolled in a program of physical therapy aimed at maintaining range of motion at the shoulder joint. Shoulder function was examined preoperatively and for 12 months postoperatively with manual muscle strength testing, range of motion measurements, and electrodiagnostic testing. Results indicate that modified nerve sparing dissections are followed on the average by a significant, but temporary and reversible phase of shoulder dysfunction. By comparison, radical neck dissection is followed by profound and permanent trapezius muscle weakness and denervation. HEAD & NECK SURGERY 8:280-286 1986We gratefully acknowledge the technical collaboration of

Anatomical Study of Accessory Nerve Innervation Relating to Functional Neck Dissection

“…When severing the main trunk of the accessory nerve, while scapular elevation is less likely to be affected, adduction will be slightly affected and lowering will be affected (33,34) . Remmler et al (35) reported that adduction was poor, agreeing with our findings. These data suggest that conserving not only the main trunk of the accessory nerve, but also the branches innervating the upper fibers of the trapezius muscle, is effective in preserving shoulder function, particularly scapular elevation.…”

Surgical Treatment of Winged Scapula

“…Surgery in the posterior cervical triangle such as lymph node biopsy, benign mass excision, or radical neck dissection places the nerve at risk. Only one case of trapezius palsy in our cohort occurred secondary to radical neck dissection, which may be in part attributable to alterations in surgical techniques to preserve the spinal accessory nerve [4,33,35]. The spinal accessory nerve is also susceptible to injury from traumatic causes.…”

Spinal Accessory Nerve Palsy: Associated Signs and Symptoms

“…18,37 SANP results in the loss of trapezius static restraint, causing shoulder girdle depression and protraction. 6,7,15,46,53 Dynamically, trapezius dysfunction results in dramatically altered scapular kinematics and limited shoulder elevation. 7,13,14,22,46,53 Diagnosis of SANP is typically achieved by identifying associated signs such as trapezius atrophy, depressed shoulder girdle, scapular dyskinesis, trapezius weakness, and limited shoulder active abduction.…”

“…7,13,14,22,46,53 Diagnosis of SANP is typically achieved by identifying associated signs such as trapezius atrophy, depressed shoulder girdle, scapular dyskinesis, trapezius weakness, and limited shoulder active abduction. 6,9,11,[13][14][15]28,29,31,46,48,49,53,52 Unfortunately, many of these signs are observational and unreliably recognized, which may explain a high rate of misdiagnosis. 3,4 Assessing scapular dyskinesis is unreliable.…”

“…40 Spinal accessory nerve injury commonly occurs during neck dissection surgery. 2,6,9,11,[13][14][15][27][28][29]31,43,46,48,49,52,53 Neck dissection surgery is performed to treat head and neck carcinoma and is categorized into 3 different procedures: radical S pinal accessory nerve palsy (SANP) is common following neck dissection surgery or lymph node excision, 2,6,9,11,[13][14][15][27][28][29]31,43,46,48,49,52,53 blunt or penetrating trauma to the lateral neck region, 2,11 and cervical stretch injuries. 32 Spinal accessory nerve injury results in trapezius paralysis or dysfunction and a diagnostic cluster of signs and symptoms, including shoulder girdle depression, trapezius atrophy, scapular dyskinesis, loss of shoulder STUDY DESIGN: Retrospective case series.…”