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Trapezius palsy, due to damage of the spinal accessory nerve, is characterized by difficulty with arm adduction and abduction, and associated with a drooping shoulder, and shoulder and neck pain. [8] Intractable trapezius palsy can be surgically managed with an Eden–Lange procedure .
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]
However, imaging studies are unable to show cause of shoulder pain in diagnosing. For example, MRI imaging would show rotator cuff pathology and bursitis but is unable to specify the cause. [15] On physical exam, the physician may twist or elevate the patient's arm to test for reproducible pain (the Neer sign and Hawkins-Kennedy test).
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 four commonly used central pain stimuli are: 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
Subacromial bursitis is a condition caused by inflammation of the bursa that separates the superior surface of the supraspinatus tendon (one of the four tendons of the rotator cuff) from the overlying coraco-acromial ligament, acromion, and coracoid (the acromial arch) and from the deep surface of the deltoid muscle. [1]
A common cause of shoulder pain in rotator cuff impingement syndrome is tendinosis, which is an age-related and most often self-limiting condition. [ 14 ] Studies show that there is moderate evidence that hypothermia (cold therapy) and exercise therapy used together are more effective than simply waiting for surgery and they suggest the best ...
Abduction and adduction of the shoulder (frontal plane). Abduction is carried out by the deltoid and the supraspinatus in the first 90 degrees. From 90-180 degrees it is the trapezius and the serratus anterior. Adduction is carried out by the pectoralis major, latissimus dorsi, teres major and the subscapularis.
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