Am Surg 1996 Aug;62(8):682-685

Diagnosis and treatment of iatrogenic spinal accessory nerve injury.

Matz PG, Barbaro NM

Although iatrogenic injury to the spinal accessory nerve in the posterior cervical triangle is a well-described phenomenon, diagnosis can prove difficult and is often incorrect or delayed. We describe a series of six men and three women (mean age 40 years; range, 20 to 52 years) with iatrogenic spinal accessory nerve injuries. Injuries resulted from lymph node biopsies in the posterior cervical triangle in eight patients and posterior foss surgery in one. Eight patients lost the ability to abduct their arm but could still shrug their shoulder, a pattern that resulted in an incorrect initial diagnosis in five patients. The average delay from injury to referral was 8 months. Seven patients underwent nerve exploration an average of 9.7 months after injury. Five had transected nerves that could be repaired; three of these patients required a nerve graft. Pain was greatly relieved in the five patients who had severe pain before surgery, and weakened shoulder abduction improved in four of six patients. Nerve expl oration should be considered when the patient's clinical exam does not improve within 3 months of injury. Nerve repair frequently reduces pain and improves shoulder abduction, even 12 months after injury. format.

Ann R Coll Surg Engl 1996 Mar;78(2):146-150

Iatrogenic accessory nerve injury.

London J, London NJ, Kay SP

Accessory nerve injury produces considerable disability. The nerve is most frequently damaged as a complication of radical neck dissection, cervical lymph node biopsy and other surgical procedures. The problem is frequently compounded by a failure to recognise the error immediately after surgery when surgical repair has the greatest chance of success. We present cases which outline the risk of accessory nerve injury, the spectrum of clinical presentations and the problems produced by a failure to recognise the deficit. Regional anatomy, consequences of nerve damage and management options are discussed. Diagnostic biopsy of neck nodes should not be undertaken as a primary investigation and, when indicated, surgery in this region should be performed by suitably trained staff under well-defined conditions. Awareness of iatrogenic injury and its consequences would avoid delays in diagnosis and treatment.

Clin Orthop 1975 May;108:15-18

Accessory spinal nerve injury.

Wright TA

In 7 cases of peripheral lesion of the spinal accessory nerve 4 were produced by malignancy, two by iatrogenical resection of lymph nodes, one by an en bloc dissection of the neck for arteriovenous malformation. Incapacity following the injury is quite marked and includes weakness of the sternomastoid and trapezius muscles, as well as pain presumably from traction on the brachial plexus. The importance of avoiding the nerve in surgical intervention in the neck must be strongly emphasized. A review of the literature suggests that in fresh injuries the spinal accessory nerve should be explored and resutured. Our own experience, however, with nerve repair has been disappointing.

Arch Phys Med Rehabil 1991 Mar;72(3):247-249

Spinal accessory nerve palsy: an unusual complication of coronary artery bypass.

Marini SG, Rook JL, Green RF, Nagler W

The neurologic complications of coronary artery bypass surgery have been well documented, with a reported incidence of 61% in one large study. Most injuries to the peripheral nervous system involve the brachial plexus. We report the first case of a spinal accessory nerve lesion after coronary bypass surgery. The patient presented with progressive right shoulder weakness. Electrodiagnostic studies revealed a partial lesion of the right spinal accessory nerve. Physical therapy, including strengthening, range of motion, and electric stimulation to the right shoulder, was prescribed to assist recovery of strength and function. Repeat electrodiagnostic studies confirmed nerve regeneration. Prompt recognition of spinal accessory nerve damage after coronary bypass surgery is essential. Early rehabilitation will improve the chances of a better functional outcome.

Muscle Nerve 1988 Feb;11(2):146-150

Stretch-induced spinal accessory nerve palsy.

Logigian EL, McInnes JM, Berger AR, Busis NA, Lehrich JR, Shahani BT

Left spinal accessory nerve palsy occurred in a young man when he quickly turned his head to the right while his shoulders were pulled down by heavy hand-held objects. Electrophysiologic studies demonstrated partial axonotmesis of the spinal accessory nerve branches innervating the sternocleidomastoid and upper and middle trapezius and complete axonotmesis of spinal accessory branches to the lower trapezius. There was a separate, although functionally minor, cervical plexus innervation of the lower trapezius.

J Neurosurg 1990 Mar;72(3):500-502

Stretch palsy of the spinal accessory nerve. Case report.

Dellon AL, Campbell JN, Cornblath D

Although sharp and blunt injury to the spinal accessory nerve has been well-documented, stretch or traction-type injury has not been reported previously. Such a case, treated successfully with nerve grafting, is described.

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