Injuries to the spinal cord nerve can cause accessory nerve disruption or spinal cord nerve nerves , leading to reduced sternocleidomastoid muscle function and upper trapezius muscle..
Video Accessory nerve disorder
Presentations
Patients with spinal accessory nerve palsies often show signs of lower motor neurone disease such as reduced muscle mass, fasciculation, and partial paralysis of sternocleidomastoid and trapezius muscles. Disturbance of the nerve supply to the sternocleidomastoid muscle produces an asymmetric neckline, while trapezius muscle weakness may produce drooping shoulders, winged scapulae, and weakness of elevation to the front of the shoulder.
Maps Accessory nerve disorder
Cause
Medical procedures are the most common cause of injury to the spinal accessory nerve. In particular, radical neck dissection and cervical lymph node biopsy is one of the most common surgical procedures that produce spinal accessory nerve damage. London notes that failure to rapidly identify spinal accessory nerve damage may exacerbate problems, as early intervention leads to better results.
Assess function
Spinal accessory nerve function is measured in neurologic examination. How examinations are conducted varies by practitioners, but often involves three components: inspection, range of motion testing, and strength testing.
During the examination, the examiner observes the sternocleidomastoid and trapezius muscles, looking for signs of a lower motor neurone disease, such as muscle atrophy and fasciculation. A winged scapula may also be suggestive of the abnormal spinal accessory nerve function, as described above.
In assessing the various movements, the examiner observes when the patient tilts and twists his head, shrugs both shoulders, and kidnaps both arms. A winged scapula due to spinal accessory nerve damage will often be exaggerated on abduction of the arm.
Strength testing is similar to the range of motion testing, except that the patient takes action against the examiner's resistance. The examiner measures the function of the sternocleidomastoid muscle by asking the patient to turn his head against resistance. Simultaneously, the examiner observed the action of the contralateral sternocleidomastoid muscle. For example, if the patient turns his head to the right, the left sternocleidomastoid muscle will usually tighten.
To assess the strength of trapezius muscles, the examiner asks the patient to shrug his shoulders from the resistance. In patients with spinal accessory nerve damage, the shoulder elevation will decrease, and the patient will not be able to shrug the shoulder against the examiner's resistance.
Treatment
There are several treatment options when iatrogenic (ie, caused by the surgeon) spinal accessory nerve damage recorded during surgery. For example, during a functional neck dissection that injures the spinal accessory nerve, the injury encourages the surgeon to carefully preserve the spinal nerve branches of C2, C3, and C4 that provide additional innervation to the trapezius muscle. Alternatively, or in addition to intraoperative procedures, postoperative procedures may also help restore the function of damaged spinal accessory nerves. For example, the Eden-Lange procedure, in which the rest of the functional shoulder muscles are repositioned by surgery, may be useful for treating trapezius muscle palsy.
References
Source of the article : Wikipedia
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