Ultrasound-guided spinal accessory nerve blockade in the diagnosis and management of trapezius muscle-related myofascial pain

Spinal accessory nerve (SAN) injury results in loss of motor function of the trapezius muscle and leads to severe shoulder problems. Primary end-to-end or graft repair is usually the standard treatment. The authors present 2 patients who presented late (8 and 10 months) after their SAN injuries, in whom a lateral pectoral nerve transfer to the SAN was performed successfully using a supraclavicular approach.

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Contralateral spinal accessory nerve for ipsilateral neurotization of branches of the brachial plexus: a cadaveric feasibility study

Journal of Neurosurgery ◽

10.3171/2011.2.jns1122 ◽

2011 ◽

Vol 114 (6) ◽

pp. 1538-1540 ◽

Cited By ~ 6

Author(s):

R. Shane Tubbs ◽

Martin M. Mortazavi ◽

Mohammadali M. Shoja ◽

Marios Loukas ◽

Aaron A. Cohen-Gadol

Keyword(s):

Brachial Plexus ◽

Spinous Process ◽

Trapezius Muscle ◽

Nerve Transfer ◽

Average Diameter ◽

Spinal Accessory Nerve ◽

Accessory Nerve ◽

Nerve Injuries ◽

Potential Donor ◽

Spinal Accessory

Object Additional nerve transfer options are important to the peripheral nerve surgeon to maximize patient outcomes following nerve injuries. Potential regional donors may also be injured or involved in the primary disease. Therefore, potential contralateral donor nerves would be desirable. To the authors' knowledge, use of the contralateral spinal accessory nerve (SAN) has not been explored for ipsilateral neurotization procedures. In the current study, therefore, the authors aimed to evaluate the SAN as a potential donor nerve for contralateral nerve injuries by using a novel technique. Methods In 10 cadavers, the SAN was harvested using a posterior approach, and tunneled subcutaneously to the contralateral side for neurotization to various branches of the brachial plexus. Measurements were made of the SAN available for transfer and of its diameter. Results The authors found an SAN length of approximately 20 cm (from transition of upper and middle fibers of the trapezius muscle to approximately 2–4 cm superior to the insertion of the trapezius muscle onto the spinous process of T-12) available for nerve transposition. The average diameter was 2.5 mm. Conclusions Based on these findings, the contralateral SAN may be considered for ipsilateral neurotization to the suprascapular and axillary nerves.

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Patient outcome after surgical management of the spinal accessory nerve injury: A long-term follow-up study

SAGE Open Medicine ◽

10.1177/2050312116645731 ◽

2016 ◽

Vol 4 ◽

pp. 205031211664573 ◽

Cited By ~ 9

Author(s):

Harry Göransson ◽

Olli V Leppänen ◽

Martti Vastamäki

Keyword(s):

Nerve Repair ◽

Trapezius Muscle ◽

Spinal Accessory Nerve ◽

Accessory Nerve ◽

Shoulder Abduction ◽

Spinal Accessory ◽

Long Term Follow Up ◽

Direct Nerve

Objectives: A lesion in the spinal accessory nerve is typically iatrogenic: related to lymph node biopsy or excision. This injury may cause paralysis of the trapezius muscle and thus result in a characteristic group of symptoms and signs, including depression and winging of the scapula, drooped shoulder, reduced shoulder abduction, and pain. The elements evaluated in this long-term follow-up study include range of shoulder motion, pain, patients’ satisfaction, delay of surgery, surgical procedure, occupational status, functional outcome, and other clinical findings. Methods: We reviewed the medical records of a consecutive 37 patients (11 men and 26 women) having surgery to correct spinal accessory nerve injury. Neurolysis was the procedure in 24 cases, direct nerve repair for 9 patients, and nerve grafting for 4. Time elapsed between the injury and the surgical operation ranged from 2 to 120 months. The patients were interviewed and clinically examined after an average of 10.2 years postoperatively. Results: The mean active range of movement of the shoulder improved at abduction 44° (43%) in neurolysis, 59° (71%) in direct nerve repair, and 30° (22%) in nerve-grafting patients. No or only slight atrophy of the trapezius muscle was observable in 75%, 44%, and 50%, and no or controllable pain was observable in 63%, 56%, and 50%. Restriction of shoulder abduction preceded deterioration of shoulder flexion. Patients’ overall dissatisfaction with the state of their upper extremity was associated with pain, lower strength in shoulder movements, and occupational problems. Conclusion: We recommend avoiding unnecessary delay in the exploration of the spinal accessory nerve, if a neural lesion is suspected.

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Nerve fascicle transfer using a part of the C-7 nerve for spinal accessory nerve injury

Journal of Neurosurgery Spine ◽

10.3171/2017.8.spine17582 ◽

2018 ◽

Vol 28 (5) ◽

pp. 555-561 ◽

Cited By ~ 2

Author(s):

Xuan Ye ◽

Yun-Dong Shen ◽

Jun-Tao Feng ◽

Wen-Dong Xu

Keyword(s):

Trapezius Muscle ◽

Nerve Transfer ◽

Jugular Foramen ◽

Spinal Accessory Nerve ◽

Accessory Nerve ◽

Spinal Accessory ◽

Linear Distance ◽

Anatomical Relationship ◽

Nerve Fascicle ◽

Posterior Division

OBJECTIVESpinal accessory nerve (SAN) injury results in a series of shoulder dysfunctions and continuous pain. However, current treatments are limited by the lack of donor nerves as well as by undesirable nerve regeneration. Here, the authors report a modified nerve transfer technique in which they employ a nerve fascicle from the posterior division (PD) of the ipsilateral C-7 nerve to repair SAN injury. The technique, first performed in cadavers, was then undertaken in 2 patients.METHODSSix fresh cadavers (12 sides of the SAN and ipsilateral C-7) were studied to observe the anatomical relationship between the SAN and C-7 nerve. The length from artificial bifurcation of the middle trunk to the point of the posterior cord formation in the PD (namely, donor nerve fascicle) and the linear distance from the cut end of the donor fascicle to both sites of the jugular foramen and medial border of the trapezius muscle (d-SCM and d-Traps, respectively) were measured. Meanwhile, an optimal route for nerve fascicle transfer (NFT) was designed. The authors then performed successful NFT operations in 2 patients, one with an injury at the proximal SAN and another with an injury at the distal SAN.RESULTSThe mean lengths of the cadaver donor nerve fascicle, d-SCM, and d-Traps were 4.2, 5.2, and 2.5 cm, respectively. In one patient who underwent proximal SAN excision necessitated by a partial thyroidectomy, early signs of reinnervation were seen on electrophysiological testing at 6 months after surgery, and an impaired left trapezius muscle, which was completely atrophic preoperatively, had visible signs of improvement (from grade M0 to grade M3 strength). In the other patient in whom a distal SAN injury was the result of a neck cyst resection, reinnervation and complex repetitive discharges were seen 1 year after surgery. Additionally, the patient’s denervated trapezius muscle was completely resolved (from grade M2 to grade M4 strength), and her shoulder pain had disappeared by the time of final assessment.CONCLUSIONSNFT using a partial C-7 nerve is a feasible and efficacious method to repair an injured SAN, which provides an alternative option for treatment of SAN injury.

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