Trapezius palsy from spinal accessory nerve injury causes a drooping, winged, laterally displaced scapula with painful weak elevation. This case series reports long-term results of the Eden-Lange procedure, which transfers the levator scapulae and both rhomboids laterally to substitute for all three parts of the trapezius. It asks whether this transfer durably relieves pain and restores function in irreparable injuries.
When you see a patient with shoulder droop, scapular winging, and weak forward elevation after a neck node biopsy, think spinal accessory nerve injury, not rotator cuff or cervical disc. Fourteen of these patients were misdiagnosed, so the practical rule is to examine the patient undressed from behind and order an EMG that specifically tests the trapezius and rhomboids.
Timing drives management. If the injury is under one year old, pursue neurolysis, repair, or grafting first, with exploration within six months giving the best chance.
The Eden-Lange transfer is the salvage option for irreparable injury in an active patient. It works by redirecting the medially inserting levator scapulae and rhomboids laterally onto the scapula to reproduce all three parts of the trapezius.
Remember that concurrent long thoracic palsy removes the other scapular upward rotator, the serratus anterior, and may need a separate pectoralis major transfer.
Trapezius palsy from spinal accessory nerve injury causes a drooping, winged, laterally displaced scapula with painful weak elevation. This case series reports long-term results of the Eden-Lange procedure, which transfers the levator scapulae and both rhomboids laterally to substitute for all three parts of the trapezius. It asks whether this transfer durably relieves pain and restores function in irreparable injuries.
When you see a patient with shoulder droop, scapular winging, and weak forward elevation after a neck node biopsy, think spinal accessory nerve injury, not rotator cuff or cervical disc. Fourteen of these patients were misdiagnosed, so the practical rule is to examine the patient undressed from behind and order an EMG that specifically tests the trapezius and rhomboids.
Timing drives management. If the injury is under one year old, pursue neurolysis, repair, or grafting first, with exploration within six months giving the best chance.
The Eden-Lange transfer is the salvage option for irreparable injury in an active patient. It works by redirecting the medially inserting levator scapulae and rhomboids laterally onto the scapula to reproduce all three parts of the trapezius.
Remember that concurrent long thoracic palsy removes the other scapular upward rotator, the serratus anterior, and may need a separate pectoralis major transfer.