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Accessory Nerve Palsy

Disorders of Accessory (11TH) Nerve


Presentation

  • We describe the previously unreported occurrence of a glomus tumour presenting with a unilateral accessory nerve palsy.[ncbi.nlm.nih.gov]
  • A positive scapular flip sign was present in all cases. The middle and lower trapezius were rated as 0/5, based on manual muscle testing, indicating no identifiable muscle activation against resistance.[ncbi.nlm.nih.gov]
  • We present the case of a 42-year-old Caucasian male suffering from a unilateral, isolated paralysis of his ipsilateral trapezius muscle. There was no related trauma, nor any past history of surgical procedures.[ncbi.nlm.nih.gov]
  • Herein, we present a patient with a diagnosis of spontaneous spinal accessory nerve palsy, which was rarely reported in the relevant literature.[ncbi.nlm.nih.gov]
  • We report the case of a 23 year old male patient who presented for an isolated left accessory nerve palsy which had appeared one year before.[ncbi.nlm.nih.gov]
Pleural Effusion
  • Risks and complications Although scapulothoracic fusion is a safe procedure, various risks and complications have been reported that include: Metalwork failure Adhesive capsulitis Nonunion of bone Pneumothorax Pleural effusion Thoracic outlet syndrome[mistysurimd.com]
Schmidt Syndrome
  • On the basis of the above findings, it was possible to diagnose Schmidt syndrome due to idiopathic accessory nerve palsy. A trial of conservative treatment for a year produced a significant improvement.[jstage.jst.go.jp]
Shoulder Pain
  • After apparently uncomplicated excision of benign lesions in the posterior cervical triangle, two patients had shoulder pain. In one, neck pain and trapezius weakness were not prominent until one month after surgery.[ncbi.nlm.nih.gov]
  • This case report suggests that isolated spinal accessory nerve palsy should be considered in cases of shoulder pain or weakness after CABG, and conservative treatment is recommended if palsy develops.[ncbi.nlm.nih.gov]
  • We report the case of a collegiate swimmer who developed left-sided neck and shoulder pain secondary to a spinal accessory nerve palsy (SANP) after a "whiplash injury," which we believe to be the first such reported case in the English language literature[ncbi.nlm.nih.gov]
  • A 38- year-old male with left shoulder pain, scapular deviation and weakness in the left upper extremity, whose symptoms developed over a two-year period following a traffic accident, is presented herein.[ncbi.nlm.nih.gov]
  • This should be considered whenever such patients complain postoperatively of ipsilateral shoulder pain/weakness or “aching” about the ear, even if some time has elapsed since surgery. 1992 by AAN Enterprises, Inc.[neurology.org]
Frozen Shoulder
  • Long-term, SAN palsy can lead to loss of muscle function, adhesive capsulitis (frozen shoulder), rotator cuff impingement, and pain. All of these side effects can greatly affect a person’s activities of daily living and quality of life.[oncolink.org]
  • shoulder , subacromial impingement , and thoracic outlet syndrome ; - Modified Eden Lange Procedure: - described by Eden in 1924 and Lange in 1959; - attempts to restore the 3 anatomical and functional aspects of the trapezius; - pt is placed in lateral[wheelessonline.com]
  • The another simple exercise to help raise your arm with a 'frozen shoulder' is the finger walking up the wall that mastectomy patients use. I've seen significant improvement noted by other club members who have tried these easy suggestions.[webwhispers.org]
  • A full passive range of motion may eventually progress to decreased passive range of motion due to adhesive capsulitis ( frozen shoulder ). The ipsilateral shoulder may droop.[emedicine.medscape.com]
Left Shoulder Pain
  • A 38- year-old male with left shoulder pain, scapular deviation and weakness in the left upper extremity, whose symptoms developed over a two-year period following a traffic accident, is presented herein.[ncbi.nlm.nih.gov]
  • Her recreational activities were also affected because she was unable to complete her swimming routine due to left shoulder pain and limited motion.[academic.oup.com]
Cranial Nerve Involvement
  • The extent of cranial nerve involvement may include the cisternal, foraminal, and extracranial (Spinal or intra Sternocleidomastoid) segments of the spinal accessory nerve (Which the extracranial form is the least common ones been reported).( 7 , 8 )[ispub.com]

Workup

  • […] in sudden acceleration-deceleration injuries). [ 18 ] Presentation Evaluation of patients to detect SAN injury requires an organized clinical examination that may be supplemented with electrophysiologic nerve and muscle studies, as described in the Workup[emedicine.medscape.com]
  • If new symptoms or significant worsening of existing symptoms occurs, neuroimaging, electrodiagnostics, or surgical referral should be considered. 8 Patients who have multiple occurrences of stingers should also have a more thorough workup, because they[aafp.org]
Pleural Effusion
  • Risks and complications Although scapulothoracic fusion is a safe procedure, various risks and complications have been reported that include: Metalwork failure Adhesive capsulitis Nonunion of bone Pneumothorax Pleural effusion Thoracic outlet syndrome[mistysurimd.com]

Treatment

  • Accessory Nerve Injury Treatment and Management. Medscape. 2016. Found at:[oncolink.org]
  • Four patients were referred to the Royal National Orthopaedic Hospital with iatrogenic accessory nerve palsy because their symptoms were severe enough to warrant surgical treatment.[ncbi.nlm.nih.gov]
  • Treatment The treatment of spinal accessory nerve palsy includes physical therapy as the main conservative or non-surgical component. For patients not responding to the conservative methods, surgery is considered for them.[mistysurimd.com]
  • If disabling pain and inability to fully elevate the arm overhead is present surgery should be considered once non-operative treatments have failed (physiotherapy and pain-killers).[shoulderdoc.co.uk]
  • A surgical reconstruction was proposed as the most efficient treatment, but our patient declined this.[scienceopen.com]

Prognosis

  • The prognosis was better following blunt trauma, stretch injuries and after a spontaneous onset. The anatomical relationships of the accessory nerve and aspects of the clinical picture and management are discussed.[ncbi.nlm.nih.gov]
  • Early identification of SANP can assist with the prognosis, explain persistent impairments and functional deficits, motivate appropriate diagnostic testing and interventions, and help maximize outcome.[ncbi.nlm.nih.gov]
  • Carenfelt C, Eliasson K (1980) Occurrence, duration and prognosis of unexpected accessory nerve paresis in radical neck dissection. Acta Otolaryngol 90:470–473 PubMed Google Scholar 8. Vastamaki M, Solonen KA (1984) Accessory nerve injury.[link.springer.com]
  • Usually the prognosis for recovery from a neuropraxia and an idiopathic lesion of the N. thoracicus longus within a two-year period is good. The prognosis for an isolated lesion of the N. accessorius is much less favourable.[ncbi.nlm.nih.gov]
  • EMG testing can help guide prognosis, direct conservative and surgical treatment, and reduce patient morbidity.[content.iospress.com]

Etiology

  • Various rare etiological factors were also described. Whatever the etiology, the typical clinical features of SAN palsy can be listed as atrophy/weakness of the trapezius muscle and moderate winging of the scapula.[ncbi.nlm.nih.gov]
  • The signs and symptoms of spinal accessory nerve palsy and its etiology are discussed.[ncbi.nlm.nih.gov]
  • A simple clinical and etiologic classification of the winged scapula is proposed based on the study of these patients in conjunction with a review of the literature. Winging of the scapula is either static or dynamic.[scienceopen.com]
  • While clinical features usually allow for a diagnosis to be made, further investigation is often warranted to determine the specific etiology. Treatment depends on the underlying etiology.[amboss.com]

Epidemiology

  • Derived from the highly acclaimed journal Best Practice & Research Clinical Endocrinology & Metabolism, this fully updated volume provides a logical progression through definition, diagnosis, epidemiology, pathology, acute and chronic complications as[books.google.com]
  • […] shoulder and upper arm level, left arm, initial encounter A- initial encounter D- subsequent encounter S- sequela Scapular Winging ICD-9 907.4 (Late effect of injury to peripheral nerve of shoulder girdle and upper limb) Scapular Winging Etiology / Epidemiology[eorif.com]
  • Compression Fracture callus Coracobrachialis muscle 5 Backpack palsy Stretch injury Multifocal motor neuropathy Upper/lower subscapular nerves Authors are not aware of any reported cases of mononeuropathy Evaluate for spinal nerve/brachial plexus lesion Epidemiology[now.aapmr.org]
  • Epidemiology Frequency Iatrogenic SAN injury most commonly occurs following diagnostic lymph node biopsies of the posterior triangle of the neck. Injury rates from these procedures are reportedly 3-8%.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • […] neuritis Syringomyelia A study by Kassem et al suggested that idiopathic brachial plexitis can affect the spinal accessory nerve and may be sparked by surgical procedures. [ 21 ] Miscellaneous Spontaneous isolated nerve injury has also been reported. [22] Pathophysiology[emedicine.medscape.com]
  • […] deltoid Sensory: C5 and C6 dermatomes No protective coverings (epineurium and perineurium) on the nerves after they exit the foramina Increased risk of stretch injury at neck and shoulder regions Contusion or compression of upper trunk at Erb point Pathophysiology[aafp.org]

Prevention

  • & Research Clinical Endocrinology & Metabolism, this fully updated volume provides a logical progression through definition, diagnosis, epidemiology, pathology, acute and chronic complications as well as the latest advances in treatment and disease prevention[books.google.com]
  • Patient & family education Counsel patient/family regarding expected course of improvement depending on type of lesion (eg neurapraxic vs axonal) and importance of physical therapy to prevent contracture and improve function.[now.aapmr.org]
  • The neurotoxin consists of molecules that bind to nerve endings and prevent the release of stimulating neurotransmitters. This means the nerve signal is blocked from reaching the muscle, and hence the muscles no longer contract.[umanitoba.ca]
  • Bilateral weakness may prevent the patient from lifting their head off a pillow and the head may be inclined posteriorly for lack of flexor tone. Bilateral weakness suggests muscle or neuromuscular disease.[dartmouth.edu]
  • [Read more] Balancing pain control has a critical role for confronting the opioid epidemic and the Centers for Disease Control and Prevention (CDC) has issued guidelines for prescribing opioids.[passioeducation.com]

References

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