Spinal accessory neuropathy
Background
Lateral neck, with accessory nerve seen between the sternocleidomastoid and trapezius muscles.
- CN XI which innervates the sternocleidomastoid and trapezius muscles[1]
- Commonly removed during radical neck dissection for head and neck cancers
Causes
- Iatrogenic
- Radical or modified neck dissection
- Trauma
- Stroke
Clinical Features
- Trapezius atrophy
- Weakness of shoulder abduction
- Scapular dyskinesis
Differential Diagnosis
Upper extremity peripheral nerve syndromes
Median Nerve Syndromes
- Carpal tunnel syndrome
- Pronator teres syndrome
- Anterior interosseous neuropathy
Ulnar Nerve Syndromes
- Ulnar neuropathy at the elbow and wrist
Radial Nerve Syndromes
- Radial neuropathy at the spiral groove (ie. "Saturday night palsy")
- Posterior interosseous neuropathy
Proximal Neuropathies
- Suprascapular neuropathy
- Long thoracic neuropathy
- Axillary neuropathy
- Spinal accessory neuropathy
- Musculocutaneous neuropathy
Evaluation
- Usually a clinical diagnosis
- Positive scapular flip sign
- Outpatient EMG or nerve conduction studies
Management
- NSAIDs
- Shoulder sling
- Physical therapy
- Surgical repair
Disposition
- Discharge with neurology follow up
External Links
References
- Kelley MJ et al. Spinal Accessory Nerve Palsy: Associated Signs and Symptoms. J Orthop Sport Phys. 2008;38(2):78-86.
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