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. 2022 May 27;49(3):440-443.
doi: 10.1055/s-0042-1748660. eCollection 2022 May.

Isolated Spinal Accessory Nerve Palsy from Volleyball Injury

Cole A Holan  1 , Brent M Egeland  2 , Steven L Henry  2
Affiliations

Isolated Spinal Accessory Nerve Palsy from Volleyball Injury

Cole A Holan et al. Arch Plast Surg. .

Abstract

Spinal accessory nerve (SAN) palsy is typically a result of posterior triangle surgery and can present with partial or complete paralysis of the trapezius muscle and severe shoulder dysfunction. We share an atypical case of a patient who presented with SAN palsy following an injury sustained playing competitive volleyball. A 19-year-old right hand dominant competitive volleyball player presented with right shoulder weakness, dyskinesia, and pain. She injured the right shoulder during a volleyball game 2 years prior when diving routinely for a ball. On physical examination she had weakness of shoulder shrug and a pronounced shift of the scapula when abducting or forward flexing her shoulder greater than 90 degrees. Manual stabilization of the scapula eliminated this shift, so we performed scapulopexy to stabilize the inferior angle of the scapula. At 6 months postoperative, she had full active range of motion of the shoulder. SAN palsy can occur following what would seem to be a routine volleyball maneuver. This could be due to a combination of muscle hypertrophy from intensive volleyball training and stretch sustained while diving for a ball. Despite delayed presentation and complete atrophy of the trapezius, a satisfactory outcome was achieved with scapulopexy.

Keywords: accessory nerve injuries; cranial nerve XI injury; spinal accessory nerve injury; spinal accessory nerve trauma.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Magnetic resonance image showing complete atrophy of the right trapezius.
Fig. 2
Fig. 2
( A ) A FiberTape suture (Arthrex, Naples, FL) was passed in the subperiosteal plane around the rib that underlay the inferior angle of the scapula, and a hole was drilled in the inferior angle of the scapula, maintaining a 2-cm bridge of bone at the medial and lateral borders. ( B ) Schematic line diagram of scapulopexy procedure.
Fig. 3
Fig. 3
Cadaveric gracilis tendons were woven with the FiberTape and passed through the scapular hole. This tendon/suture construct was cinched in a Pulvertaft weave to allow just a few millimeters of motion between the inferior angle of the scapula and the rib.
See this image and copyright information in PMC

References

    1. Rosse C, Gaddum-Rosse P. Philadelphia, PA: Lippincott Williams & Wilkins; 1997. Hollinshead's Textbook of Anatomy, 5th ed.
    1. Vastamäki M, Solonen K A. Accessory nerve injury. Acta Orthop Scand. 1984;55(03):296–299. - PubMed
    1. Charopoulos I N, Hadjinicolaou N, Aktselis I, Lyritis G P, Papaioannou N, Kokoroghiannis C. Unusual insidious spinal accessory nerve palsy: a case report. J Med Case Reports. 2010;4(01):158. - PMC - PubMed
    1. Eisen A, Bertrand G. Isolated accessory nerve palsy of spontaneous origin. A clinical and electromyographic study. Arch Neurol. 1972;27(06):496–502. - PubMed
    1. Sergides N N, Nikolopoulos D D, Polyzois I G. Idiopathic spinal accessory nerve palsy. A case report. Orthop Traumatol Surg Res. 2010;96(05):589–592. - PubMed