Surgical Management of Trapezius Palsy

Scapular Winging

“…If diagnosed early, spinal accessory neurolysis or nerve repair can be considered and Teboul et al reported good or excellent results in 16 of 20 cases, concluding that the procedure should be performed within 20 months of injury [67,71,72]. If this early window for nerve surgery is missed, then the best evidence is for reconstruction with an Eden-Lange procedure [10,67,68,71,[73][74][75].…”

Trapezius Palsy Resulting from Accessory Nerve Injury after Cervical Lymph Node Biopsy Dramatically Improved with Conservative Treatment

“…One report suggested a vigorous rehabilitation program for late-diagnosed SAN injury to achieve a gain of function in the affected extremities, 11) but most reports suggest Eden-Lange muscle transfer because the re-educated muscles of the shoulder girdle can only partially compensate for the permanently paralyzed trapezius. 9,12,13) In our case, no symptoms were detectable after 3 months of rehabilitation, so we assumed that the improvement was achieved by recovery of the nerve.…”

Surgical Treatment of Winged Scapula

“…Patients with neurapraxic injury can be treated nonoperatively (eg, observation, physical therapy to strengthen compensatory muscles) and followed with serial electromyography. Neurolysis, nerve repair, or nerve graft is generally considered in injuries caused by surgery or penetrating trauma, preferably within 6 to 12 months of the injury [26,36]. One patient in the Eden-Lange group had undergone unsuccessful spinal accessory nerve graft.…”

“…We believe layered closure and use of a drain help decrease dead space and remove any residual fluid. A recent study detailing a technique for the Eden-Lange procedure suggested using two suction drains [36]. The patient who had a combined Eden-Lange procedure and split pectoralis major transfer may have been at higher risk to develop a seroma because multiple surgical planes were developed during the same operation.…”