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Additional muscle deficits can contraindicate tendon transfer, namely the serratus anterior muscle or the muscles-to-be-transferred themselves. Serratus anterior muscle deficit is another cause of scapular winging and decreases the efficacy of an Eden–Lange procedure, but it can be overcome with a simultaneous pectoralis major transfer .
There are several options of treatment when iatrogenic (i.e., caused by the surgeon) spinal accessory nerve damage is noted during surgery. For example, during a functional neck dissection that injures the spinal accessory nerve, injury prompts the surgeon to cautiously preserve branches of C2, C3, and C4 spinal nerves that provide supplemental innervation to the trapezius muscle. [3]
the trapezius squeeze - which involves gripping and twisting a portion of the trapezius muscle in the patient's shoulder [1] mandibular pressure - this is the manual stimulation of the mandibular nerve , located within the angle of the jaw
Injury to the accessory nerve can result in neck pain and weakness of the trapezius muscle. Symptoms will depend on at what point along its length the nerve was severed. [5] Injury to the nerve can result in shoulder girdle depression, atrophy, abnormal movement, a protruding scapula, and weakened abduction. [5]
The two muscles most commonly inhibited during this first part of an overhead motion are the serratus anterior and the lower trapezius. [10] These two muscles act as a force couple within the glenohumeral joint to properly elevate the acromion process, and if a muscle imbalance exists, shoulder impingement may develop.
An example of trapezius function is an overhead press. When activating together, the upper and lower fibers also assist the middle fibers (along with other muscles such as the rhomboids) with scapular retraction/adduction. The trapezius also assists in abduction of the shoulder above 90 degrees by rotating the glenoid upward.
Some injuries, particularly lesions, can paralyse the serratus anterior muscle to produce a winged scapula. [3] [12] This is most prominent when the arm is lifted forward or when the patient pushes the outstretched arm against a wall. However, even winging may not be evident until the trapezius stretches enough to reveal an injury several weeks ...
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