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Annals of Rehabilitation Medicine Oct 2018Spinal accessory nerve (SAN) injury mostly occurs during surgical procedures. SAN injury caused by manipulation therapy has been rarely reported. We present a rare case...
Spinal accessory nerve (SAN) injury mostly occurs during surgical procedures. SAN injury caused by manipulation therapy has been rarely reported. We present a rare case of SAN injury associated with manipulation therapy showing scapular winging and droopy shoulder. A 42-year-old woman visited our outpatient clinic complaining of pain and limited active range of motion (ROM) in right shoulder and scapular winging after manipulation therapy. Needle electromyography and nerve conduction study suggested SAN injury. Physical therapy (PT) three times a week for 2 weeks were prescribed. After a total of 6 sessions of PT and modality, the patient reported that the pain was gradually relieved during shoulder flexion and abduction with improved active ROM of shoulder. Over the course of 2 months follow-up, the patient reported almost recovered shoulder ROM and strength as before. She did not complain of shoulder pain any more.
PubMed: 30404427
DOI: 10.5535/arm.2018.42.5.773 -
Integrative Cancer Therapies 2021Spinal accessory nerve dysfunction is one of the complications of neck dissection in patients with oral cancer. This study aimed to explore the effects of long-term... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
Spinal accessory nerve dysfunction is one of the complications of neck dissection in patients with oral cancer. This study aimed to explore the effects of long-term scapular-focused exercises and conscious control of scapular orientation on scapular movement and quality of life (QoL).
METHODS
This study was a randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Thirty-six patients with oral cancer were randomly allocated to the motor-control group (scapular-focused exercise + conscious control of scapular orientation) or the regular-exercise group (scapular-focused exercises only). Both groups received conventional physical therapy after neck dissection for 3 months. Shoulder pain intensity, active range of motion (AROM) of shoulder abduction, scapular muscle strength and activity under maximal voluntary isometric contraction (MVIC), scapular muscle activity when performing scapular movements, and QoL were measured at baseline, 1 month after the start of the intervention, and the end of the intervention.
RESULTS
Both groups showed significant improvement in all outcomes except shoulder pain intensity. After the 3-month intervention, the motor-control group had more significant improvement in AROM of shoulder abduction with a 19° difference (95% CI: 10-29, < .001), muscle strength of upper trapezius with an 11 N difference (95% CI: 2-20; = .021), and QoL than the regular-exercise group. When performing shoulder horizontal adduction and flexion, the relative value (%MVIC) of serratus anterior was smaller in the motor-control group with a 106%MVIC difference (95% CI: 7-205, = .037).
CONCLUSIONS
Scapular-focused exercises have promising effects on spinal accessory nerve dysfunction. Combining scapular-focused exercises with conscious control of scapular orientation has more remarkable benefits on AROM of shoulder abduction, UT muscle strength, and muscle activation pattern than the scapular-focused exercises alone. Conscious control of scapular orientation should be considered to integrate into scapular-focused exercises in patients with oral cancer and scapular dyskinesis.Trial registry name and URL, and registration number: ClinicalTrials.gov (URL: https://clinicaltrials.gov; Approval No: NCT03545100).
Topics: Cancer Survivors; Electromyography; Exercise Therapy; Humans; Mouth Neoplasms; Quality of Life; Superficial Back Muscles
PubMed: 34412536
DOI: 10.1177/15347354211040827 -
Plastic and Reconstructive Surgery.... Sep 2015Modified radical neck dissection (mRND) [preserving the sternocleidomastoid muscle (SCM) and the spinal accessory nerve] and supraomohyoid neck dissection have become...
BACKGROUND
Modified radical neck dissection (mRND) [preserving the sternocleidomastoid muscle (SCM) and the spinal accessory nerve] and supraomohyoid neck dissection have become common surgical procedures for treating head and neck cancer. Postoperative severe asymmetry of the neck and severe atrophy of the SCM, however, have been demonstrated.
METHODS
Using computed tomographic images, cross-sectional areas of the SCMs were measured in 99 patients with carcinoma of the oral cavity who underwent unilateral mRND or supraomohyoid neck dissection. An asymmetry index was used.
RESULTS
Innervation to the SCM was preserved in 91 patients. The spinal accessory nerve and the innervation were sacrificed in 3 patients; the innervation was repaired in 5 patients. Sacrifice of innervation to the SCM resulted in extremely severe asymmetry. Repair of the innervation prevented severe asymmetry in 40%. Preservation of the innervation prevented severe asymmetry in 75% at the middle portion of the neck and in 56% at the lower portion after mRND.
CONCLUSION
Preserving innervation to the SCM and gentle handling of the nerve during neck dissection could prevent severe asymmetry after neck dissection.
PubMed: 26495217
DOI: 10.1097/GOX.0000000000000457 -
The Journal of Bone and Joint Surgery.... Jan 2011The integrity of the spinal accessory nerve is fundamental to thoracoscapular function and essential for scapulohumeral rhythm. This nerve is vulnerable along its...
The integrity of the spinal accessory nerve is fundamental to thoracoscapular function and essential for scapulohumeral rhythm. This nerve is vulnerable along its superficial course. This study assessed the delay in diagnosis and referral for management of damage to this nerve, clarified its anatomical course and function, and documented the results of repair. From examination of our records, 111 patients with lesions of the spinal accessory nerve were treated between 1984 and 2007. In 89 patients (80.2%) the damage was iatropathic. Recognition and referral were seldom made by the surgeon responsible for the injury, leading to a marked delay in instituting treatment. Most referrals were made for painful loss of shoulder function. The clinical diagnosis is straightforward. There is a characteristic downward and lateral displacement of the scapula, with narrowing of the inferior scapulohumeral angle and loss of function, with pain commonly present. In all, 80 nerves were explored and 65 were repaired. The course of the spinal accessory nerve in relation to the sternocleidomastoid muscle was constant, with branches from the cervical plexus rarely conveying motor fibres. Damage to the nerve was predominantly posterior to this muscle. Despite the delay, the results of repair were surprising, with early relief of pain, implying a neuropathic source, which preceded generally good recovery of muscle function.
Topics: Accessory Nerve; Accessory Nerve Injuries; Accidents, Traffic; Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Nerve Transfer; Pain; Peripheral Nerves; Recovery of Function; Shoulder Joint; Treatment Outcome; Violence; Young Adult
PubMed: 21196545
DOI: 10.1302/0301-620X.93B1.24202 -
Singapore Medical Journal Dec 2009We report a 56-year-old Malay woman with a tumour that involved the skin and caused hyoid bone erosion. There was no clinical or radiological evidence of regional lymph...
We report a 56-year-old Malay woman with a tumour that involved the skin and caused hyoid bone erosion. There was no clinical or radiological evidence of regional lymph node involvement. A modified radical neck dissection with preservation of the accessory nerve and internal jugular vein was performed, followed by an "extended" Sistrunk operation. The surgical defect was reconstructed with a pectoralis major myocutaneous flap. Our literature review showed that this is the first reported thyroglossal duct carcinoma which involved the skin and required a pedicle flap reconstruction.
Topics: Adenocarcinoma, Papillary; Aged, 80 and over; Female; Head and Neck Neoplasms; Humans; Neck Dissection; Sentinel Lymph Node Biopsy; Skin Neoplasms; Surgical Flaps
PubMed: 20087540
DOI: No ID Found -
Neurology India 2013
Review
Topics: Accessory Nerve; Accessory Nerve Diseases; Humans; Paralysis
PubMed: 23466850
DOI: 10.4103/0028-3886.108021 -
Cureus Jun 2018The accessory nerve is an important nerve in the head and neck regions. Some variants of this nerve's anatomy have been reported. Herein, we present an unusual report...
The accessory nerve is an important nerve in the head and neck regions. Some variants of this nerve's anatomy have been reported. Herein, we present an unusual report and review the extant medical literature regarding other more commonly found derailments of this nerve's anatomy.
PubMed: 30109167
DOI: 10.7759/cureus.2774 -
Hand (New York, N.Y.) Jul 2019Carpal tunnel release (CTR) is the most common hand surgery operation performed in the United States. While serious complications are rare, they can be life-altering to...
Carpal tunnel release (CTR) is the most common hand surgery operation performed in the United States. While serious complications are rare, they can be life-altering to patients. In some cases, patients will pursue malpractice claims against the surgeon. This study aimed to understand the patient, procedure, and surgeon factors involved in CTR malpractice litigation. The Westlaw legal database was queried for all recorded CTR malpractice cases resulting in jury verdicts and settlements. Only cases directly related to injury after CTR were included in this study. Cases were reviewed to determine plaintiff demographics, defendant training, liability, injury, outcomes, and monetary awards. Ninety-two unique cases were identified. Plaintiffs were predominantly female (n = 65, 71%). Most surgeons were orthopedic-trained (n = 37, 52%). Only 27% of defendants (n = 19) were hand fellowship-trained. Only 19% of cases resulting in a monetary award were against surgeons who had hand fellowship training. The majority of cases (n = 61, 66%) were found in favor of the defendant. Monetary awards averaged $305 923 (range = $12 000-1 338 147), while settlements averaged $266 250. Alleged liability was most for surgeon negligence (n = 69, 75%) with a third of cases resulting in monetary awards. Median nerve injury was claimed in 41 cases (45%), with 17 (41%) resulting in monetary awards. Although CTR is generally safe and effective, some patients will experience complications. Median nerve injury was the most common reason for successful litigation in this study. Adequate training and experience in hand surgery may lower the risk of injuries resulting in successful malpractice suits.
Topics: Accessory Nerve Injuries; Adult; Carpal Tunnel Syndrome; Databases, Factual; Decompression, Surgical; Fellowships and Scholarships; Female; Humans; Jurisprudence; Liability, Legal; Male; Malpractice; Median Nerve; Surgeons; United States
PubMed: 29529876
DOI: 10.1177/1558944718760032 -
Scientific Reports Aug 2021The lophophore is a tentacle organ unique to the lophophorates. Recent research has revealed that the organization of the nervous and muscular systems of the lophophore...
The lophophore is a tentacle organ unique to the lophophorates. Recent research has revealed that the organization of the nervous and muscular systems of the lophophore is similar in phoronids, brachiopods, and bryozoans. At the same time, the evolution of the lophophore in certain lophophorates is still being debated. Innervation of the adult lophophore has been studied by immunocytochemistry and confocal laser scanning microscopy for only two brachiopod species belonging to two subphyla: Linguliformea and Rhynchonelliformea. Species from both groups have the spirolophe, which is the most common type of the lophophore among brachiopods. In this study, we used transmission electron microscopy, immunocytochemistry, and confocal laser scanning microscopy to describe the innervation of the most complex lophophore (the plectolophe) of the rhynchonelliform species Coptothyris grayi. The C. grayi lophophore (the plectolophe) is innervated by three brachial nerves: the main, second accessory, and lower. Thus, the plectolophe lacks the accessory brachial nerve, which is typically present in other studied brachiopods. All C. grayi brachial nerves contain two types of perikarya. Because the accessory nerve is absent, the cross nerves, which pass into the connective tissue, have a complex morphology: each nerve consists of two ascending and one descending branches. The outer and inner tentacles are innervated by several groups of neurite bundles: one frontal, two lateral, two abfrontal, and two latero-abfrontal (the latter is present in only the outer tentacles). Tentacle nerves originate from the second accessory and lower brachial nerves. The inner and outer tentacles are also innervated by numerous peritoneal neurites, which exhibit acetylated alpha-tubulin-like immunoreactivity. The nervous system of the lophophore of C. grayi manifests several evolutionary trends. On the one hand, it has undergone simplification, i.e., the absence of the accessory brachial nerve, which is apparently correlated with a reduction in the complexity of the lophophore's musculature. On the other hand, C. grayi has a prominent second accessory nerve, which contains large groups of frontal perikarya, and also has additional nerves extending from the both ganglia to the medial arm; these features are consistent with the complex morphology of the C. grayi plectolophe. In brachiopods, the evolution of the lophophore nervous system apparently involved two main modifications. The first modification was the appearance and further strengthening of the second accessory brachial nerve, which apparently arose because of the formation of a double row of tentacles instead of the single row of the brachiopod ancestor. The second modification was the partial or complete reduction of some brachial nerves, which was correlated with the reduced complexity of the lophophore musculature and the appearance of skeletal structures that support the lophophore.
Topics: Animals; Biological Evolution; Invertebrates; Nervous System; Nervous System Physiological Phenomena; Organogenesis
PubMed: 34376709
DOI: 10.1038/s41598-021-95584-5 -
Journal of Neurosurgery. Case Lessons Aug 2023Spinal accessory nerve palsy can lead to severe shoulder pain and weakness, lateral scapular winging, and limitations in overhead activity. It most often occurs because...
BACKGROUND
Spinal accessory nerve palsy can lead to severe shoulder pain and weakness, lateral scapular winging, and limitations in overhead activity. It most often occurs because of iatrogenic injury from procedures within the posterior triangle of the neck.
OBSERVATIONS
The authors present the case of a 39-year-old male with symptoms of right shoulder weakness and neck pain after a total thyroidectomy and right neck dissection. With ultrasound findings of a neuroma-in-continuity but no clinical or electromyographic signs of reinnervation at 6 months, surgical intervention was indicated. Operative exploration confirmed a very proximal injury and nonconducting neuroma-in-continuity of the spinal accessory nerve. A selective distal nerve transfer from the posterior division of the upper trunk was performed. At the 2.5-year follow-up, the patient demonstrated excellent recovery of full active shoulder abduction and forward flexion, return to full-time employment, and mild residual scapular winging.
LESSONS
Distal nerve transfers should be considered in cases of late presentation when primary repair is not possible or long interpositional grafts are required. Selective fascicular transfer from the posterior division of the upper trunk provides the advantages of a single incision, short reinnervation time, and synergistic donor function to facilitate motor reeducation.
PubMed: 37728327
DOI: 10.3171/CASE23348