Abstract
IntroductionIsolated spinal accessory nerve dysfunction has a major detrimental impact on the functional performance of the shoulder girdle, and is a well-documented complication of surgical procedures in the posterior triangle of the neck. To the best of our knowledge, the natural course and the most effective way of handling spontaneous spinal accessory nerve palsy has been described in only a few instances in the literature.Case presentationWe report the case of a 36-year-old Caucasian, Greek man with spontaneous unilateral trapezius palsy with an insidious course. To the best of our knowledge, few such cases have been documented in the literature. The unusual clinical presentation and functional performance mismatch with the imaging findings were also observed. Our patient showed a deterioration that was different from the usual course of this pathology, with an early onset of irreversible trapezius muscle dysfunction two months after the first clinical signs started to manifest. A surgical reconstruction was proposed as the most efficient treatment, but our patient declined this. Although he failed to recover fully after conservative treatment for eight months, he regained moderate function and is currently virtually pain-free.ConclusionClinicians have to be aware that due to anatomical variation and the potential for compensation by the levator scapulae, the clinical consequences of any injury to the spinal accessory nerve may vary.
Highlights
Isolated spinal accessory nerve dysfunction has a major detrimental impact on the functional performance of the shoulder girdle, and is a well-documented complication of surgical procedures in the posterior triangle of the neck
The role of the trapezius muscle in shoulder girdle kinesiology is fundamental, since it contributes to the scapulothoracic rhythm by elevating, rotating and retracting the scapula
We report a case of spontaneous unilateral trapezius palsy with an insidious course, which has been documented in only a few instances in the literature [3,8,9]
Summary
Isolated spinal accessory nerve dysfunction has a serious impact on the functional performance of the shoulder girdle. Physical examination revealed a winged scapula and asymmetry of his shoulders, with right shoulder depression (Figure 1) He was unable to abduct his right arm above 80° in the frontal or scapular plane while his forward elevation was slightly reduced. EMG of his right sternocleidomastoid muscle showed findings suggestive of mild axonal injury (decreased recruitment, polyphasicity and prolonged duration with increased amplitude of motor unit potentials) His levator scapulae, serratus anterior and rhomboid muscles were normal. Our patient refused the recommended treatment, since he felt that his painless disability did not justify this highly demanding procedure Instead he followed a specific program of physiotherapy, focusing on resistance exercises to progressively strengthen the adjacent scapular muscles and on exercises to preserve the maximum range of motion of his shoulder joint. A repeat EMG did not show any alterations from the initial electrophysiological findings
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