Spinal accessory neuropathy: Difference between revisions

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==Background==
==Background==
[[File:Gray1210.png|thumb|Lateral neck, with accessory nerve seen between the sternocleidomastoid and trapezius muscles.]]
*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==
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==Differential Diagnosis==
==Differential Diagnosis==
*Iatrogenic
{{Upper extremity peripheral nerve syndromes}}
**Radical or modified neck dissection
*Trauma
*[[Stroke]]


==Evaluation==
==Evaluation==
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==Management==
==Management==
*NSAIDs
*[[NSAIDs]]
*Shoulder sling
*Shoulder sling
*Physical therapy
*Physical therapy
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==See Also==
==See Also==
[[Neurologic exam]]
*[[Neurologic exam]]
*[[Peripheral nerve syndromes]]


==External Links==
==External Links==
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==References==
==References==
<references/>
<references/>
[[Category:Neurology]]

Latest revision as of 18:13, 5 August 2020

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

Ulnar Nerve Syndromes

Radial Nerve Syndromes

Proximal Neuropathies

Other

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

  1. Kelley MJ et al. Spinal Accessory Nerve Palsy: Associated Signs and Symptoms. J Orthop Sport Phys. 2008;38(2):78-86.