Study of the cervical plexus innervation of the trapezius muscle

2011 ◽  
Vol 14 (5) ◽  
pp. 626-629 ◽  
Author(s):  
R. Shane Tubbs ◽  
Mohammadali M. Shoja ◽  
Marios Loukas ◽  
Jeffrey Lancaster ◽  
Martin M. Mortazavi ◽  
...  
Keyword(s):  
Fiber Type ◽  
Trapezius Muscle ◽  
Immunohistochemical Analysis ◽  
Nerve Transfer ◽  
Nerve Fibers ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Type I ◽  
Cervical Nerve ◽  
Spinal Accessory

Object There is conflicting and often anecdotal evidence regarding the potential motor innervation of the trapezius muscle by cervical nerves, with most authors attributing such fibers to proprioception. As knowledge of such potential motor innervations may prove useful to the neurosurgeon, the present study aimed to elucidate this anatomy further. Methods Fifteen adult cadavers (30 sides) underwent dissection of the posterior triangle of the neck and harvesting of cervical nerve fibers found to enter the trapezius muscle. Random fibers were evaluated histologically to determine fiber type (that is, motor vs sensory axons). Results In addition to an innervation from the spinal accessory nerve, the authors also identified cervical nerve innervations of all trapezius muscles. For these innervations, 3 sides were found to have fibers derived from C-2 to C-4, 2 sides had fibers derived from C-2 to C-3, and 25 sides had fibers derived from C-3 to C-4. Fibers derived from C-2 to C-4 were classified as a Type I innervation, those from C-2 to C-3 were classified as a Type II innervation, and those from C-3 to C-4 were classified as a Type III innervation. Immunohistochemical analysis of fibers from each of these types confirmed the presence of motor axons. Conclusions Based on the authors' study, cervical nerves innervate the trapezius muscle with motor fibers. These findings support surgical and clinical experiences in which partial or complete trapezius function is maintained after injury to the spinal accessory nerve. The degree to which these nerves innervate this muscle, however, necessitates further study. Such information may be useful following nerve transfer procedures, denervation techniques for cervical dystonia, or sacrifice of the spinal accessory nerve due to pathological entities.

scholarly journals Lateral pectoral nerve transfer for spinal accessory nerve injury

2017 ◽  
Vol 26 (1) ◽  
pp. 112-115 ◽  
Author(s):  
Andrés A. Maldonado ◽  
Robert J. Spinner
Keyword(s):  
Nerve Injury ◽  
Motor Function ◽  
Standard Treatment ◽  
Trapezius Muscle ◽  
Nerve Transfer ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Supraclavicular Approach ◽  
Spinal Accessory ◽  
Pectoral Nerve

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.

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.

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

2018 ◽  
Vol 28 (5) ◽  
pp. 555-561 ◽  
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.

scholarly journals Recovery of trapezius muscle paralysis in neck dissection in which the spinal accessory nerve was preserved

Toukeibu Gan ◽  
2008 ◽  
Vol 34 (1) ◽  
pp. 67-70 ◽  
Author(s):  
Tetsuro Onitsuka ◽  
Mitsuru Ebihara ◽  
Yoshiyuki Iida ◽  
Tomoyuki Kamijyo ◽  
Rie Asano ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Trapezius Muscle ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Muscle Paralysis ◽  
Spinal Accessory

A novel method of lengthening the accessory nerve for direct coaptation during nerve repair and nerve transfer procedures

2018 ◽  
Vol 128 (1) ◽  
pp. 272-276
Author(s):  
R. Shane Tubbs ◽  
Andrés A. Maldonado ◽  
Yolanda Stoves ◽  
Fabian N. Fries ◽  
Rong Li ◽  
...  
Keyword(s):  
Nerve Repair ◽  
Nerve Transfer ◽  
Nerve Fibers ◽  
Accessory Nerve ◽  
Cervical Nerve ◽  
Neural Connections ◽  
Direct Repair ◽  
Novel Method ◽  
Time Distance ◽  
Transfer Procedures

OBJECTIVEThe accessory nerve is frequently repaired or used for nerve transfer. The length of accessory nerve available is often insufficient or marginal (under tension) for allowing direct coaptation during nerve repair or nerve transfer (neurotization), necessitating an interpositional graft. An attractive maneuver would facilitate lengthening of the accessory nerve for direct coaptation. The aim of the present study was to identify an anatomical method for such lengthening.METHODSIn 20 adult cadavers, the C-2 or C-3 connections to the accessory nerve were identified medial to the sternocleidomastoid (SCM) muscle and the anatomy of the accessory nerve/cervical nerve fibers within the SCM was documented. The cervical nerve connections were cut. Lengths of the accessory nerve were measured. Samples of the cut C-2 and C-3 nerves were examined using immunohistochemistry.RESULTSThe anatomy and adjacent neural connections within the SCM are complicated. However, after the accessory nerve was “detethered” from within the SCM and following transection, the additional length of the accessory nerve increased from a mean of 6 cm to a mean of 10.5 cm (increase of 4.5 cm) after cutting the C-2 connections, and from a mean of 6 cm to a mean length of 9 cm (increase of 3.5 cm) after cutting the C-3 connections. The additional length of accessory nerve even allowed direct repair of an infraclavicular target (i.e., the proximal musculocutaneous nerve). The cervical nerve connections were shown not to contain motor fibers.CONCLUSIONSAn additional length of the accessory nerve made available in the posterior cervical triangle can facilitate direct repair or neurotization procedures, thus eliminating the need for an interpositional nerve graft, decreasing the time/distance for regeneration and potentially improving clinical outcomes.

An anatomic study of the spinal accessory nerve: Extended harvest permits direct nerve transfer to distal plexus targets

2007 ◽  
Vol 20 (8) ◽  
pp. 899-904 ◽  
Author(s):  
Torpon Vathana ◽  
Mikko Larsen ◽  
Godard C.W. de Ruiter ◽  
Allen T. Bishop ◽  
Robert J. Spinner ◽  
...  
Keyword(s):  
Nerve Transfer ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Anatomic Study ◽  
Spinal Accessory ◽  
Direct Nerve

Reconstruction of the spinal accessory nerve with selective fascicular nerve transfer of the upper trunk

2019 ◽  
Vol 31 (1) ◽  
pp. 133-138 ◽  
Author(s):  
Johannes A. Mayer ◽  
Laura A. Hruby ◽  
Stefan Salminger ◽  
Gerd Bodner ◽  
Oskar C. Aszmann
Keyword(s):  
Brachial Plexus ◽  
Nerve Repair ◽  
Nerve Transfer ◽  
Axillary Nerve ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Nerve Function ◽  
Analog Scale ◽  
Spinal Accessory ◽  
Active Range Of Motion

OBJECTIVESpinal accessory nerve palsy is frequently caused by iatrogenic damage during neck surgery in the posterior triangle of the neck. Due to late presentation, treatment regularly necessitates nerve grafts, which often results in a poor outcome of trapezius function due to long regeneration distances. Here, the authors report a distal nerve transfer using fascicles of the upper trunk related to axillary nerve function for reinnervation of the trapezius muscle.METHODSFive cases are presented in which accessory nerve lesions were reconstructed using selective fascicular nerve transfers from the upper trunk of the brachial plexus. Outcomes were assessed at 20 ± 6 months (mean ± SD) after surgery, and active range of motion and pain levels using the visual analog scale were documented.RESULTSAll 5 patients regained good to excellent trapezius function (3 patients had grade M5, 2 patients had grade M4). The mean active range of motion in shoulder abduction improved from 55° ± 18° before to 151° ± 37° after nerve reconstruction. In all patients, unrestricted shoulder arm movement was restored with loss of scapular winging when abducting the arm. Average pain levels decreased from 6.8 to 0.8 on the visual analog scale and subsided in 4 of 5 patients.CONCLUSIONSRestoration of spinal accessory nerve function with selective fascicle transfers related to axillary nerve function from the upper trunk of the brachial plexus is a good and intuitive option for patients who do not qualify for primary nerve repair or present with a spontaneous idiopathic palsy. This concept circumvents the problem of long regeneration distances with direct nerve repair and has the advantage of cognitive synergy to the target function of shoulder movement.

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