Combined Injury of the Accessory Nerve and Brachial Plexus

Neurosurgery ◽  
2011 ◽  
Vol 68 (2) ◽  
pp. 390-396 ◽  
Author(s):  
Jayme Augusto Bertelli ◽  
Marcos Flávio Ghizoni
Keyword(s):  
Electrical Stimulation ◽  
Brachial Plexus ◽  
Nerve Palsy ◽  
Head Tilt ◽  
Trapezius Muscle ◽  
Sternocleidomastoid Muscle ◽  
Accessory Nerve ◽  
Surgical Reconstruction ◽  
Motor Branch ◽  
Upper Trapezius

Abstract BACKGROUND: Stretch-induced spinal accessory nerve palsy has been considered extremely rare, with only a few cases reported. OBJECTIVE: In 357 patients with stretch lesions of the brachial plexus, we investigated the prevalence, course, and surgical treatment of accessory nerve palsy. METHODS: Accessory nerve palsy was ascertained when the patient was unable to shrug the ipsilateral shoulder. Patients underwent brachial plexus reconstruction between 6 and 8 months after trauma. To confirm paralysis, during surgery, the accessory nerve was stimulated electrically. RESULTS: Accessory nerve palsy occurred in 19 of the 327 patients (6%) with upper type or complete palsy of the brachial plexus. Proximal injuries of the accessory nerve accompanied by voice alteration and complete palsy of the sternocleidomastoid and trapezius muscle occurred in 2 patients. Proximal palsy without vocal alterations was observed in 6 patients. Palsy of the trapezius muscle with preservation of the sternocleidomastoid muscle occurred in 11 patients. All 7 patients who demonstrated muscle contractions upon electrical stimulation of the accessory nerve during surgery recovered completely. Patients with surgical reconstruction of the accessory nerve through grafting (n = 2) or repair by platysma motor nerve transfer (n = 2) recovered active shoulder shrugging within 36 months of surgery. Seven of the 8 patients without accessory nerve reconstruction recovered from their drop shoulder and head tilt, but remained unable to shrug. CONCLUSION: If intraoperative electrical stimulation produces contraction of the upper trapezius muscle, no repair is needed. In proximal injuries, the platysma motor branch should be transferred to the accessory nerve; whereas in paralysis distal to the sternocleidomastoid muscle, the accessory nerve should be explored and grafted.

Transfer of the Platysma Motor Branch to the Accessory Nerve in a Patient With Trapezius Muscle Palsy and Total Avulsion of the Brachial Plexus

Neurosurgery ◽  
2011 ◽  
Vol 68 (2) ◽  
pp. E567-E570 ◽  
Author(s):  
Jayme Augusto Bertelli ◽  
Marcos Flávio Ghizoni
Keyword(s):  
Brachial Plexus ◽  
Motor Nerve ◽  
Trapezius Muscle ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Suprascapular Nerve ◽  
Accessory Nerve ◽  
Shoulder Abduction ◽  
Motor Branch ◽  
Upper Trapezius

Abstract BACKGROUND AND IMPORTANCE: To report on the successful use of a platysma motor nerve transfer to the accessory nerve in a patient with concomitant trapezius and brachial plexus palsy. CLINICAL PRESENTATION: A 20-year-old man presented with total avulsion of the right brachial plexus combined with palsies of the accessory and phrenic nerve. The patient was operated on 4 months after his injury. The accessory nerve was repaired via direct transfer of the platysma motor branch. The contralateral C7 root was connected to the musculocutaneous nerve, and the hemihypoglossal nerve was grafted to the suprascapular nerve. Two intercostal nerves were attached to the triceps long head motor branch. CONCLUSION: Within 20 months of surgery, the patient regained full reinnervation of the upper trapezius muscle. Elbow flexion scored M3+, and 30° active shoulder abduction was observed. Triceps reinnervation was poor. Platysma motor branch transfer to the accessory nerve is a viable alternative to reinnervate the trapezius muscle.

THE ACCESSORY NERVE AND THE CERVICAL PLEXUS: ANATOMY AND CLINICAL IMPLICATIONS

Hand Surgery ◽  
1996 ◽  
Vol 01 (02) ◽  
pp. 113-121
Author(s):  
Wing-Cheung Wu ◽  
Ying-Lee Lam ◽  
Yun-Po Chang ◽  
Kai-Chung Poon ◽  
Kin-Ming Au
Keyword(s):  
Brachial Plexus ◽  
Trapezius Muscle ◽  
Accessory Nerve ◽  
Clinical Implications ◽  
Brachial Plexus Palsy ◽  
Cervical Plexus ◽  
Motor Branch ◽  
Applied Anatomy ◽  
Deep Branch ◽  
Posterior Triangle

The accessory nerve and the motor branch of the cervical plexus have been used as donor nerves in neurotisation procedures for brachial plexus palsy. However, there are few reports in the literature that describe their anatomy in detail. The aim of this study is to delineate the applied anatomy of these nerves. We emphasise their course in the posterior triangle of the neck as well as within the trapezius muscle. Fourteen cadavers were dissected. We identified nerves not reported before and they are the lateral cutaneous branches of C3 and C4. The deep branch of C4 is present in all the cases; it supplies the trapezius muscle and we believe it contains motor fibres. The accessory nerve gives a branch in the neck in only one case. The accessory nerve joins the deep branch of C4 in 93.3% of the cases. Clinical implications of the findings would be discussed.

scholarly journals Motion Analytics of Trapezius Muscle Activity in an 18-Year-Old Female with Extended Upper Brachial Plexus Birth Palsy

2021 ◽  
Vol 16 (01) ◽  
pp. e51-e55
Author(s):  
Jasmine J. Lin ◽  
Gromit Y.Y. Chan ◽  
Cláudio T. Silva ◽  
Luis G. Nonato ◽  
Preeti Raghavan ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Upper Extremity ◽  
Muscle Activity ◽  
Visual Analytics ◽  
Three Dimensional ◽  
Trapezius Muscle ◽  
Shoulder Abduction ◽  
Upper Trapezius ◽  
Brachial Plexus Birth Palsy ◽  
Birth Palsy

Abstract Background The trapezius muscle is often utilized as a muscle or nerve donor for repairing shoulder function in those with brachial plexus birth palsy (BPBP). To evaluate the native role of the trapezius in the affected limb, we demonstrate use of the Motion Browser, a novel visual analytics system to assess an adolescent with BPBP. Method An 18-year-old female with extended upper trunk (C5–6–7) BPBP underwent bilateral upper extremity three-dimensional motion analysis with Motion Browser. Surface electromyography (EMG) from eight muscles in each limb which was recorded during six upper extremity movements, distinguishing between upper trapezius (UT) and lower trapezius (LT). The Motion Browser calculated active range of motion (AROM), compiled the EMG data into measures of muscle activity, and displayed the results in charts. Results All movements, excluding shoulder abduction, had similar AROM in affected and unaffected limbs. In the unaffected limb, LT was more active in proximal movements of shoulder abduction, and shoulder external and internal rotations. In the affected limb, LT was more active in distal movements of forearm pronation and supination; UT was more active in shoulder abduction. Conclusion In this female with BPBP, Motion Browser demonstrated that the native LT in the affected limb contributed to distal movements. Her results suggest that sacrificing her trapezius as a muscle or nerve donor may affect her distal functionality. Clinicians should exercise caution when considering nerve transfers in children with BPBP and consider individualized assessment of functionality before pursuing surgery.

Accessory nerve palsy following carotid endarterectomy

1985 ◽  
Vol 63 (4) ◽  
pp. 630-632 ◽  
Author(s):  
Karl W. Swann ◽  
Roberto C. Heros
Keyword(s):  
Carotid Endarterectomy ◽  
Nerve Palsy ◽  
Sternocleidomastoid Muscle ◽  
Accessory Nerve ◽  
Content Type ◽  
Stretch Injury ◽  
Fine Print

✓ Two patients who had an accessory nerve palsy following carotid endarterectomy are presented. Both patients had high carotid bifurcations necessitating unusually high retraction and dissection. The ipsilateral accessory nerve was injured in the anterior cervical triangle in both cases. It is believed that vigorous lateral retraction of the superior aspect of the sternocleidomastoid muscle led to a stretch injury of the nerve. The symptoms completely resolved in both patients within 6 months.

Improved Technique for Harvesting the Accessory Nerve for Transfer in Brachial Plexus Injuries

2006 ◽  
Vol 58 (suppl_4) ◽  
pp. ONS-366-ONS-370 ◽  
Author(s):  
Jayme Augusto Bertelli ◽  
Marcos Flavio Ghizoni
Keyword(s):  
Brachial Plexus ◽  
Lymphatic Vessels ◽  
Trapezius Muscle ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Accessory Nerve ◽  
Fat Tissue ◽  
Anterior Border ◽  
Improved Technique ◽  
Nerve Identification

Abstract Objective: The accessory nerve is frequently used as a donor for nerve transfer in brachial plexus injuries. In currently available techniques, nerve identification and dissection is difficult because fat tissue, lymphatic vessels, and blood vessels surround the nerve. We propose a technique for location and dissection of the accessory nerve between the deep cervical fascia and the trapezius muscle. Methods: Twenty-eight patients with brachial plexus palsy had the accessory nerve surgically transplanted to the suprascapular nerve. To harvest the accessory nerve, the anterior border of the trapezius muscle was located 2 to 3 cm above the clavicle. The fascia over the trapezius muscle was incised and detached from the anterior surface of the muscle, initially, close to the clavicle, then proximally. The trapezius muscle was detached from the clavicle for 3 to 4 cm. The accessory nerve and its branches entering the trapezius muscle were identified. The accessory nerve was sectioned as distally as possible. To allow for accessory nerve mobilization, one or two proximal branches to the trapezius muscle were cut. The most proximal branch was always identified and preserved. A tunnel was created in the detached fascia, and the accessory nerve was passed through this tunnel to the brachial plexus. Results: In all of the cases, the accessory nerve was easily identified under direct vision, without the use of electric stimulation. Direct coaptation of the accessory nerve with the suprascapular nerve was possible in all patients. Conclusion: The technique proposed here for harvesting the accessory nerve for transfer made its identification and dissection easier.

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

2011 ◽  
Vol 114 (6) ◽  
pp. 1538-1540 ◽  
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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