Definition and Diagnosis

The spinal accessory nerve is located under the skin on the side of the neck and controls the trapezius muscle, which stabilizes the scapula and shrugs the shoulder. This nerve may be damaged with surgery or trauma involving the neck (e.g., lymph node biopsy). Symptoms include shoulder pain, scapular winging, and weakness/atrophy of the trapezius muscle. Diagnosis is confirmed with a history and examination. Electrical testing helps determine prognosis and the severity of injury.

Treatment Options

This patient had their spinal accessory nerve
accidentally cut during a lymph node biopsy.

Depending on the type of injury, surgery to repair this nerve may need to be performed immediately, or 3 to 6 months after injury. If it is uncertain if this nerve was indeed cut, then close follow-up with serial electrical tests helps determine if surgery will be required. Physical therapy is the mainstay of treatment during this interim. Therapy is performed regardless of whether surgery is indicated. It improves range of motion and encourages a return of strength once contraction occurs.

Surgery is performed in the main operating room under general anesthesia. Most patients go home either the same day, or the day after surgery. At surgery, the spinal accessory nerve is exposed in the neck and examined with a microscope as well as with electrical testing. Cut nerves are repaired, and scarred nerves are often repaired with a nerve graft (see technology and techniques available section). Because no muscles or bones have to cut for this procedure, postoperative pain is minimal and the recovery from surgery itself is quite short (week or two).

Nerve regeneration, however, can take 3-12 months, during which time physical therapy is performed. Patients with a spinal accessory nerve injury older than 1-2 years may not be a candidate for nerve surgery. Options for these patients include tendon/muscle transfer techniques to stabilize the scapula and reduce pain.