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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 second category is the lateral winging which is caused by injury of the spinal accessory nerve. Severe atrophy of the trapezius is seen with accidental damage to the spinal accessory nerve during lymph node biopsy of the neck. There are numerous ways in which the long thoracic nerve can sustain trauma-induced injury.
The accessory nerve, also known as the eleventh cranial nerve, cranial nerve XI, or simply CN XI, is a cranial nerve that supplies the sternocleidomastoid and trapezius muscles. It is classified as the eleventh of twelve pairs of cranial nerves because part of it was formerly believed to originate in the brain.
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From here, the accessory nerve courses through the posterior triangle of the neck to enter the anterior border of the trapezius muscle at a point located approximately at the junction of the middle and lower thirds of the anterior border of this muscle. The spinal accessory nerve can often be found 1 cm above Erb's point. [4]
Dorsal scapular nerve syndrome can be caused by nerve compression syndrome. A winged scapula is the most common symptom. [7] Shoulder pain may occur. [7] It causes weakness in rhomboid major muscle, rhomboid minor muscle, and levator scapulae muscle. [7] The range of motion of the shoulder may be limited. [7] Treatment is usually conservative. [7]
Scapular winging due to trapezius muscle (spinal accessory nerve) palsy can be treated with an Eden-Lange procedure. Scapular winging due to facioscapulohumeral muscular dystrophy can be treated with a scapulopexy or scapulothoracic fusion.
The spinal root of accessory nerve (or part) is firm in texture, and its fibers arise from the motor cells in the lateral part of the anterior column of the gray substance of the medulla spinalis as low as the fifth cervical nerve.