Idiopathic spinal accessory nerve injury
Palsy of the eleventh cranial nerve – or spinal accessory nerve (SAN) − is a rare cause of scapular winging, leading to painful upper extremity disability due to weakness and atrophy of the trapezius muscle. Most SAN injuries are iatrogenic, and no specific pediatric epidemiology is known.
Herein is described the case of a 17-year-old adolescent referred to Physical and Rehabilitation Medicine consultation due to insidious right shoulder pain with two years of evolution.
Shoulder pain combined with muscular atrophy is suggestive of nerve lesion. Electromyography is the gold standard exam and showed segmental demyelination and axonotmesis in this case. After evaluation, the patient underwent physiotherapy, with excellent results.
In conclusion, SAN injury treatment can be conservative or surgical and physiotherapy is the basis of early treatment in most cases. Recovery can occur even after a significant period of time.
Camp SJ, Birch R. Injuries to the spinal accessory nerve. J Bone Joint Surg. 2011; 93-B: 62-7.
Chandawarkar RY, Cervino AL, Pennington GA. Management of iatrogenic injury to the spinal accessory nerve. Plast Reconstr Surg. 2003; 111:611-7.
London J, London N, Kay S. latrogenic accessory nerve injury. Ann R Coll Surg Engl. 1996; 78:146-50.
Valtonen EJ, Lilius HG. Late sequelae of iatrogenic spinal accessory nerve injury. Acta Chir Scand. 1974; 140:453-5.
Prim MP, De Diego JI, Verdaguer JM, Sastre N, Rabanal I. Neurological complications following functional neck dissection. Eur Arch Otorhinolaryngol. 2006; 263:473-6.
Grossman JAI, Ruchelsman DE, Schwarzkopf R. Iatrogenic spinal accessory nerve injury in children. J Pediatric Surg. 2008. 43:1732-5.
Nakamichi KI, Tachibana S. Iatrogenic injury of the spinal accessory nerve. J Bone Joint Surg Am .1998; 80:1616–21.
Shen J, Chen W, Ye X, Qiu Y, Xu J, Zhu Y, et al. Ultrasound in the management of iatrogenic spinal accessory nerve palsy at the posterior cervical triangle area. Muscle Nerve. 2018; 59:64-9.
Nguyen C, Guérini H, Roren A, Zauderer J, Vuillemin V, Seror P, et al. Neuromuscular dynamic scapular winging: Clinical, electromyographic and magnetic resonance imaging diagnosis. Presse Med. 2015; 44:1256-65.
Akgun K, Aktas I, Uluc K. Conservative treatment for late-diagnosed spinal accessory nerve injury. Am J Phys Med Rehabil. 2008; 87:1015-21.
Göransson H, Leppänen OV, Vastamäki M. Patient outcome after surgical management of the spinal accessory nerve injury: A long-term follow-up study. SAGE Open Med. 2016; 4:2050312116645731.
Copyright (c) 2020 NASCER E CRESCER - BIRTH AND GROWTH MEDICAL JOURNAL
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and access
This journal offers immediate free access to its content, following the principle that providing free scientific knowledge to the public provides greater global democratization of knowledge.
The works are licensed under a Creative Commons Attribution Non-commercial 4.0 International license.
Nascer e Crescer – Birth and Growth Medical Journal do not charge any submission or processing fee to the articles submitted.