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Iatrogenic Injury of the Spinal Accessory Nerve. Results of Repair*
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Investigation performed at the Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo
J Bone Joint Surg Am, 1998 Nov 01;80(11):1616-21
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We reviewed the results of repair of the spinal accessory nerve in seven patients seen between September 1994 and January 1996. The nerve had been injured during biopsy of a cervical lymph node in six patients and during removal of a bullet in one. The average interval between the time of the injury and the repair of the nerve was eight months (range, three to fourteen months). An end-to-end repair of the nerve was performed in six patients, and a neurolysis was done in one. The average duration of follow-up was thirty-two months (range, twenty-four to thirty-nine months).Postoperatively, all seven patients had relief of pain and stiffness in the shoulder girdle. Manual muscle-testing revealed normal strength of the trapezius, which was comparable with that on the unaffected side. Four patients regained normal function of the shoulder. Three patients reported a stretching sensation or discomfort in the neck, periscapular discomfort, and fatigue of the extremity when lifting heavy objects or performing overhead activities. However, these residual symptoms were mild and tolerable and thus were different in nature from the preoperative pain and stiffness.Iatrogenic injury of the spinal accessory nerve should be suspected if a patient has pain or stiffness in the shoulder girdle and a history of a recent operation on the neck. The nerve should be explored if spontaneous recovery does not occur.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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