Spinal accessory neuropathy: Difference between revisions
No edit summary |
No edit summary |
||
Line 3: | Line 3: | ||
*CN XI which innervates the sternocleidomastoid and trapezius muscles<ref>Kelley MJ et al. Spinal Accessory Nerve Palsy: Associated Signs and Symptoms. J Orthop Sport Phys. 2008;38(2):78-86.</ref> | *CN XI which innervates the sternocleidomastoid and trapezius muscles<ref>Kelley MJ et al. Spinal Accessory Nerve Palsy: Associated Signs and Symptoms. J Orthop Sport Phys. 2008;38(2):78-86.</ref> | ||
*Commonly removed during radical neck dissection for head and neck cancers | *Commonly removed during radical neck dissection for head and neck cancers | ||
==Causes== | |||
*Iatrogenic | |||
**Radical or modified neck dissection | |||
*Trauma | |||
*[[Stroke]] | |||
==Clinical Features== | ==Clinical Features== | ||
Line 10: | Line 16: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Peripheral nerve syndromes}} | |||
==Evaluation== | ==Evaluation== |
Revision as of 18:08, 5 August 2020
Background
- 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
Peripheral nerve syndromes
- Upper extremity
- Ulnar
- Cause of Injury: Elbow injury.
- Sensory changes in the 5th and medial half of 4th digits, weak wrist flexors, “claw hand”
- Radial
- Cause of Injury: Distal humeral shaft fracture, anterior shoulder dislocation, supra-condylar fracture, Radial neuropathy at the spiral groove, Posterior interosseous neuropathy
- “Wrist drop,” weakness of finger extensors. +/- sensory loss over the dorsum of the hand, weak thumb adduction
- Median, distal
- Cause of Injury: Wrist dislocation, laceration, Carpal Tunnel Syndrome
- Weak flexion of radial half of digits and thumb, loss of abduction and opposition of thumb. Ape hand deformity, benediction sign. Loss of sensation of lateral three and one-half digits and nail beds
- Median, proximal
- Cause of Injury: Supracondylar humeral fracture, Pronator teres syndrome, Anterior interosseous neuropathy, tight cast
- See Median, distal above, loss of forearm pronation, loss of radial half digits and thumb flexion
- Musculocutaneous
- Cause of Injury: Anterior shoulder dislocation, entrapment due to hypertrophy
- Elbow flexion and supination weakness, radial forearm sensory deficits
- Axillary
- Cause of Injury: Anterior shoulder dislocation, inferior shoulder dislocation, proximal humerus fracture
- Weak arm abduction (from 15 to 90 degrees), weak shoulder flexion, extension and rotation of shoulder, loss of sensation of upper lateral arm
- Suprascapular
- Cause of Injury: Paralabral cyst, bone/soft tissue tumor, Scapular fracture, traction injury, Parsonage-Turner syndrome
- Weak arm abduction to 90 degrees, weak shoulder flexion to 30 degrees, weak internal rotation
- Ulnar
- Lower extremity
- Femoral
- Cause of Injury: Pubic rami fracture, pelvic fractures
- Weak knee extension, anterior knee sensory deficits
- Obturator
- Cause of Injury: Obturator ring fracture, obturator nerve entrapment
- Weak hip adduction, medial thigh sensory deficit
- Posterior tibial
- Cause of Injury: Knee dislocation
- Weak toe flexion, plantar foot sensory deficit
- Superficial peroneal
- Cause of Injury: Fibular neck fracture, knee dislocation
- Weak ankle eversion, lateral dorsal foot sensory deficits
- Deep peroneal
- Cause of Injury: Fibular neck fracture, compartment syndrome
- Sensory deficit at dorsal 1st web space, weak ankle and toe dorsiflexion
- Sciatic
- Cause of Injury: Posterior hip dislocation
- Lower leg weakness, foot drop, leg sensory deficits
- Superior gluteal
- Cause of Injury: Acetabular pelvic fracture
- Trendelenburg’s gait, Trendelenburg’s sign
- Inferior gluteal
- Cause of Injury: Acetabular pelvic fracture, s/p hip replacement
- Abnormal gait, gluteus maximus weakness resulting in gluteus maximus lurch
- Femoral
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
See Also
External Links
References
- ↑ Kelley MJ et al. Spinal Accessory Nerve Palsy: Associated Signs and Symptoms. J Orthop Sport Phys. 2008;38(2):78-86.