Spinal Accessory Nerve Palsy: Associated Signs and Symptoms

Kelley, Martin J.; Kane, Thomas E.; Leggin, Brian G.

doi:10.2519/jospt.2008.2454

Cited by 63 publications

(56 citation statements)

References 46 publications

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“…However, nerve injuries, due to a traumatic blow, a severe stretch or traction, or laceration, are common in sports 26 and can be found secondary to various surgical interventions. 21, 28 This model of scapular dyskinesis, created by utilizing a nerve injury mechanism, is appropriate because it does mimic the clinical condition of scapular “winging” and does provide a consistent, repeatable method of inducing scapular dyskinesis, allowing us to address our primary hypothesis. Specifically, this model was designed to investigate the effect of scapular dyskinesis on tendon healing and was not developed to address the etiology of scapular dyskinesis.…”

Section: Discussionmentioning

confidence: 99%

Effect of scapular dyskinesis on supraspinatus repair healing in a rat model

Reuther

Tucker

Thomas

et al. 2015

Journal of Shoulder and Elbow Surgery

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Background Rotator cuff tears are common conditions that often require surgical repair to improve function and relieve pain. Unfortunately, repair failure remains a common problem following rotator cuff repair surgery. Several factors may contribute to repair failure including age, tear size, and time from injury. However, the mechanical mechanisms resulting in repair failure are not well understood making clinical management difficult. Specifically, altered scapular motion (termed scapular dyskinesis) may be one important and modifiable factor contributing to the risk of repair failure. Therefore, the objective of this study was to determine the effect of scapular dyskinesis on supraspinatus tendon healing following repair. Methods A rat model of scapular dyskinesis was used. 70 adult male Sprague-Dawley rats (400-450 grams) were randomized into two groups: nerve transection of the accessory and long-thoracic nerves (SD) or sham nerve transection (Sham Control). Following this procedure, all rats underwent unilateral detachment and repair of the supraspinatus tendon. All rats were sacrificed at 2, 4, and 8 weeks after surgery. Shoulder function, passive joint mechanics, and tendon properties (mechanical, histological, organizational, and compositional) were evaluated. Results Scapular dyskinesis alters joint function and may lead to compromised supraspinatus tendon properties. Specifically, diminished mechanical properties, altered histology, and decreased tendon organization was observed for some parameters. Conclusion This study identifies scapular dyskinesis as one underlying mechanism leading to compromise of supraspinatus healing following repair. Identifying modifiable factors that lead to compromised tendon healing will help improve clinical outcomes following repair. Level of evidence Basic Science, in-vivo Animal Study.

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Section: Discussionmentioning

confidence: 99%

Effect of scapular dyskinesis on supraspinatus repair healing in a rat model

Reuther

Tucker

Thomas

et al. 2015

Journal of Shoulder and Elbow Surgery

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“…Findings of late sequelae are drooping of the shoulder, atrophy of the trapezius, weakness or loss of shoulder abduction, pain and sensory disturbance in the forearm and fingers, and winging of the scapula (1,5).…”

Section: Iatrogenic Accessory Nerve Lesionmentioning

confidence: 99%

“…Spinal accessory nerve palsy [SANP] produces considerable disability. Pain, wasting of the trapezius muscle, drooping of the shoulder, protraction of the scapula, and scapular winging on abduction of the arm are most frequently noted (1). Normal scapulothoracic rhythm is disrupted (2).…”

Section: Introductionmentioning

confidence: 99%

The Anterior Cervical Triangle: An Unusual Site for Iatrogenic Accessory Nerve Palsy – A Case Report

Aydemir

Tezel

Duman

et al. 2012

Journal of Musculoskeletal Pain

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ABackground: Injury to the spinal accessory nerve [SAN] results in a debilitating shoulder dysfunction. Iatrogenic injury is common during radical neck dissection, cervical lymph node biopsy, and other surgical procedures; thus the superficial course of the nerve in posterior cervical triangle [PCT] makes it susceptible. The anterior cervical triangle [ACT] is an unusual location for iatrogenic SAN injury. Findings: We present a case that outlines the risk of SAN injury following a surgical operation in the ACT. Conclusions: Prevention of inadvertent injury to the SAN is also critical in the ACT, as well as in the PCT section.

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“…A positive scapular flip sign occurs when the medial scapular border "flips" up, or lifts from the thoracic wall during resisted shoulder external rotation. 5 The flip sign is also present in patients with a partial return of the upper trapezius, which acts as an upward rotator and elevator. Therefore, even when active, it cannot oppose the pull of the humeral external rotators.…”

mentioning

confidence: 99%

“…11 Other diagnoses that should be ruled out include cervical radiculopa- thy, brachial plexopathy/neuritis, and long thoracic nerve palsy, which cause some combination of shoulder girdle depression, limited shoulder motion, and cervical/scapular pain. 5 Some physicians erroneously rule out SAN injury if the patient can shrug his or her shoulders, but the levator scapula muscle normally assists the trapezius muscle in this function and can therefore produce a shrug on the affected side. 1 Presenting symptoms of SAN injuries are not subtle and occur either immediately after the procedure or soon afterward.…”

mentioning

confidence: 99%

Surgical outcomes of 156 spinal accessory nerve injuries caused by lymph node biopsy procedures

Park

Esquenazi

Kline

et al. 2015

SPI

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OBJECT Iatrogenic injuries to the spinal accessory nerve (SAN) are not uncommon during lymph node biopsy of the posterior cervical triangle (PCT). In this study, the authors review the operative techniques and surgical outcomes of 156 surgical repairs of the SAN following iatrogenic injury during lymph node biopsy procedures. METHODS This retrospective study examines the authors’ clinical and surgical experience with 156 patients with SAN injury between 1980 and 2012. All patients suffered iatrogenic SAN injuries during lymph node biopsy, with the vast majority (154/156, 98.7%) occurring in Zone I of the PCT. Surgery was performed on the basis of anatomical and electro-physiological findings at the time of the operation. The mean follow-up period was 24 months (range 8–44 months). RESULTS Of the 123 patients who underwent graft or suture repair, 107 patients (87%) improved to Grade 3 functionality or higher using the Louisiana State University Health Science Center (LSUHSC) grading system. Neurolysis was performed in 29 patients (19%) when the nerve was found in continuity with recordable nerve action potential (NAP) across the lesion. More than 95% of patients treated by neurolysis with positive NAP recordings recovered to LSUHSC Grade 3 or higher. Forty-one patients (26%) underwent end-to-end repair, while 82 patients (53%) underwent graft repair, and Grade 3 or higher recovery was assessed for 90% and 85% of these patients, respectively. The average graft length used was 3.81 cm. Neurotization was performed in 4 patients, 2 of whom recovered to Grade 2 and 3, respectively. CONCLUSIONS SAN injuries present challenges for surgical exploration and repair because of the nerve’s size and location in the PCT. However, through proper and timely intervention, patients with diminished or absent function achieved favorable functional outcomes. Surgeons performing lymph node biopsy procedures in Zone I of the PCT should be aware of the potential risk of injury to the SAN.

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Spinal Accessory Nerve Palsy: Associated Signs and Symptoms

Cited by 63 publications

References 46 publications

Effect of scapular dyskinesis on supraspinatus repair healing in a rat model

Effect of scapular dyskinesis on supraspinatus repair healing in a rat model

The Anterior Cervical Triangle: An Unusual Site for Iatrogenic Accessory Nerve Palsy – A Case Report

Surgical outcomes of 156 spinal accessory nerve injuries caused by lymph node biopsy procedures

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