A Very Rare Cause of Shoulder Weakness: Concurrent Traumatic Neuropathies of Accessory, Long Thoracicus, and Suprascapular Nerves

Authors

Department of Neurology, Hacettepe University Hospital, Ankara, Turkey

10.4103/atr.atr_61_17

Abstract

Accessory nerve is one of the most sensitive cranial nerves to injury, and its injuries are usually caused by iatrogenic interventions. As many
other causes can mimic its clinical presentation, careful physical examination should be performed while evaluating a patient suspected of
accessory neuropathy. In this report, we aimed to illustrate a very rare case with concurrent traumatic cranial neuropathies of accessory nerve,
suprascapular nerve, and long thoracicus. A 16‑year‑old boy was admitted with complaints of shoulder weakness and pain following a trauma of
strain injury. He had first taken the misdiagnosis of brachial plexopathy; however, after a detailed physical examination and electrophysiological
study, the diagnosis of concurrent traumatic neuropathies of accessory, suprascapular, and long thoracicus nerves was made. In our opinion,
during evaluation of these rare traumatic neuropathies, detailed clinical evaluations combined with detailed electromyography investigations
may give crucial data for the proper diagnosis.

Keywords

References

1. Standring S. Gray’s Anatomy: The Anatomical Basis of Clinical
Practice. 41th edition of Gray's Anatomy: 2015.
2. "Spinal accessory nerve''. Structure of the human body. Loyala
University Medical Education Network. ARchived from the original
2007.
3. Mariani PP, Santoriello P, Maresca G. Spontaneous accessory nerve
palsy. J Shoulder Elbow Surg 1998;7:545‑6.
4. Donner TR, Kline DG. Extracranial spinal accessory nerve injury.
Neurosurgery 1993;32:907‑10.
5. Fankhauser F, Schippinger G. Suprascapular nerve entrapment by
a ganglion cyst: An alternative method of treatment. Orthopedics
2002;25:87‑8.
6. Salazar JD, Doty JR, Tseng EE, Marin PC, Girotto JA, Roseborough GS,
et al. Relationship of the long thoracic nerve to the scapular tip: An
aid to prevention of proximal nerve injury. J Thorac Cardiovasc Surg
1998;116:960‑4.
7. Wiater JM, Bigliani LU. Spinal accessory nerve injury. Clin Orthop
Relat Res 1999;368:5‑16.
8. Bodack MP, Tunkel RS, Marini SG, Nagler W. Spinal accessory nerve
palsy as a cause of pain after whiplash injury: Case report. J Pain
Symptom Manage 1998;15:321‑8.
9. Sweeney PJ, Wilbourn AJ. Spinal aSccessory (11th) nerve palsy
following carotid endarterectomy. Neurology 1992;42:674‑5.
10. Braybrooke J, Kumar C, Morris E. Spinal accessory nerve palsy
following blunt trauma. Injury 2003;34:948‑9.
11. Kierner AC, Burian M, Bentzien S, Gstoettner W. Intraoperative
electromyography for identification of the trapezius muscle
innervation: Clinical proof of a new anatomical concept. Laryngoscope
2002;112:1853‑6.
12. Avery BW, Pilon FM, Barclay JK. Anterior coracoscapular ligament and
suprascapular nerve entrapment. Clin Anat 2002;15:383‑6.
13. Safran MR. Nerve injury about the shoulder in athletes, part 2: Long
thoracic nerve, spinal accessory nerve, burners/stingers, thoracic outlet
syndrome. Am J Sports Med 2004;32:1063‑76.

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History

  • Receive Date: 20 May 2017
  • Accept Date: 20 May 2017

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