This review addresses spinal accessory nerve injury and the resulting trapezius palsy. It covers the relevant anatomy, why the nerve is vulnerable, how to evaluate a drooping winged shoulder, and how to treat it. The authors describe their preferred modified Eden-Lange muscle transfer for irreparable injury.
When you see a drooping shoulder, asymmetric neckline, and scapular winging after neck surgery, think spinal accessory nerve injury until proven otherwise.
The classic history is a lymph node biopsy or neck dissection followed by pain, fatigue with overhead use, and difficulty abducting past 90 degrees. This diagnosis is missed constantly, so anchor it with EMG of the trapezius, SCM, levator, rhomboids, and serratus.
Timing drives management. An acute nerve injury under 1 year old warrants consideration of microsurgical repair or grafting, and results are best within the first 6 months.
For irreparable injury in an active patient who has failed a year of therapy, the Eden-Lange transfer is the workhorse. It works because moving the levator and rhomboid insertions laterally lengthens the moment arm and reproduces the trapezius three functional components. Always rule out a concomitant serratus (long thoracic) palsy first, since it compromises the transfer.
This review addresses spinal accessory nerve injury and the resulting trapezius palsy. It covers the relevant anatomy, why the nerve is vulnerable, how to evaluate a drooping winged shoulder, and how to treat it. The authors describe their preferred modified Eden-Lange muscle transfer for irreparable injury.
When you see a drooping shoulder, asymmetric neckline, and scapular winging after neck surgery, think spinal accessory nerve injury until proven otherwise.
The classic history is a lymph node biopsy or neck dissection followed by pain, fatigue with overhead use, and difficulty abducting past 90 degrees. This diagnosis is missed constantly, so anchor it with EMG of the trapezius, SCM, levator, rhomboids, and serratus.
Timing drives management. An acute nerve injury under 1 year old warrants consideration of microsurgical repair or grafting, and results are best within the first 6 months.
For irreparable injury in an active patient who has failed a year of therapy, the Eden-Lange transfer is the workhorse. It works because moving the levator and rhomboid insertions laterally lengthens the moment arm and reproduces the trapezius three functional components. Always rule out a concomitant serratus (long thoracic) palsy first, since it compromises the transfer.