The Modified Eden-Lange Tendon Transfer for Lateral Scapular Winging Secondary to Spinal Accessory Nerve Injury

Abstract

Trapezius paralysis following injury to the spinal accessory nerve can be a debilitating complication resulting from lymph node biopsy, radical neck dissection, or penetrating trauma in the region of the posterior cervical triangle. Disruption of the delicate muscular balance in the shoulder girdle may result in lateral scapular winging, ipsilateral upper extremity radiculopathy, and limited shoulder function and range of motion. Spontaneous recovery with nonoperative management is possible in some patients, and restoration of function after reparative neural procedures has been observed in patients undergoing timely repair. However, extended delays from the time of injury to surgery are common and may necessitate various muscle transfers to reestablish the complex biomechanics and balance of the shoulder girdle. We describe a modification to the classic Eden-Lange procedure with lateral transfer of the levator scapulae and rhomboid minor to the scapula spine and rhomboid major transfer with a small wafer of bone to the scapula body for chronic lateral winging of the scapula following injury to the spinal accessory nerve as the result of a cervical lymph node biopsy.

Muscle Tendon Transfers Around the Shoulder

“…The Eden-Lange procedure has been the classic surgical procedure for the treatment of STAM resulting from trapezius palsy (spinal accessory nerve palsy) (Table V). This procedure lateralizes the insertions of the rhomboid minor and major to the midbody of the scapula and the levator scapulae to the scapular spine to stabilize the scapula (Video 2) 22 . Good to excellent mid-term and long-term outcomes, including reduced pain and improved active forward elevation and abduction as well as patient-reported clinical outcomes, have been documented 23,24 .…”

“…The technique is performed with the patient in either the prone 22 or the lateral position (Fig. 3-A).…”

“…continued the midbody of the scapula and the levator scapulae to the scapular spine to stabilize the scapula (Video 2) 22 . Good to excellent mid-term and long-term outcomes, including reduced pain and improved active forward elevation and abduction as well as patient-reported clinical outcomes, have been documented 23,24 .…”

Which Components of the Simple Shoulder Test Show Improvement After Scapulothoracic Fusion for Recalcitrant Scapular Winging? Clinical Results at a Minimum of 5 Years of Follow-up

“…In patients with nerve palsy of the long thoracic, spinal accessory, or dorsal scapular nerves or combined nerve injuries from Parsonage-Turner syndrome (acute brachial plexus neuritis), a prolonged course of nonoperative management allows time for nerve recovery. In patients who do not improve with nonsurgical management, a variety of soft tissue procedures can be considered, such as split pectoralis major transfer for long thoracic nerve palsy and the Eden-Lange or triple tendon transfer for spinal accessory nerve palsy [3,4,6,11]. However, some patients have persistent symptoms despite these soft tissue procedures, and some are not appropriate candidates for them (such as patients with brachial plexus palsy affecting multiple nerve roots that supply the pectoralis major, rhomboids, or levator scapulae).…”

Triple Tendon Transfer of the Levator Scapulae, Rhomboid Major, and Rhomboid Minor to Reconstruct the Paralyzed Trapezius

“…Trapezius paralysis is a relatively rare condition most associated with iatrogenic spinal accessory nerve damage from a lymph node biopsy procedure, radical neck dissection, and blunt or penetrating trauma to the posterior cervical triangle. 1 The trapezius muscle functions to rotate the scapula and assist in shoulder abduction. Trapezius paralysis in turn can result in shoulder drooping, pain, weakness, loss of shoulder abduction, and lateral scapular winging.…”