Iatrogenic injury of the spinal accessory nerve

Case contributed by Dr Maulik S Patel

Presentation

About 10 weeks before the presentation, the patient underwent right cervical lymph node biopsy. She developed right shoulder pain after the procedure. The patient was referred for ultrasound evaluation of rotator cuff and spinal accessory nerve.

Patient Data

Age: 40 years
Gender: Female

The spinal accessory nerve was traced in the right lateral cervical triangle region. The nerve is encased by the hypoechoic scar region. There is edema of nerve with loss of normal fascicular pattern at the site of involvement. The nerve segment caudal to scar also shows mild edema. There are few subcentimeter sized ovoid nodes locally which are normal nodes. There is no fatty infiltration or atrophy of affected trapezius muscle in comparison to the contralateral side.

The rotator cuff is intact with normal echopattern. There is no effusion in the subacromial-subdeltoid bursa or glenohumeral joint.

There is no fracture/ dislocation/ bone lesion. The glenohumeral joint and acromioclavicular joints are normal.

Surgery revealed about 20 mm long segment of the spinal accessory nerve trapped in the scar. After nerve isolation, intraoperative nerve stimulation showed a suboptimal response. The sural nerve was used for the graft.

Case Discussion

The case shows iatrogenic injury to the spinal accessory nerve after biopsy for a cervical lymph node.

Histopathology of the lymph node revealed non-neoplastic, non-infective etiology.

Surgical details and photos courtesy: Operating surgeon Dr. Vitrag Shah.

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