Complete Spinal Accessory Nerve Palsy From Carrying Climbing Gear

Weightlifting Induced Spinal Accessory Nerve Palsy and Winged Scapula: A Case Report

Winged scapula is a rare musculoskeletal condition with numerous etiologies including spinal accessory nerve (SAN) palsy. Sport activities are rarely implicated with few scattered case reports. We report a case of an 18-year-old bodybuilder who suffered SAN palsy secondary to weightlifting exercises. Physical examination revealed winged scapula with painful mobility of the shoulder. A scapular magnetic resonance imaging scan and electromyography of the trapezius muscle were performed and confirmed the diagnosis of SAN palsy. Through this case, we review the literature of common and rare causes of SAN palsy and outline accepted treatment options.

Spinal Accessory Nerve Injury following Spinal Adjustment: Case Report and Literature Review of the Outcome of Accessory Nerve Pathology as Result of Blunt Trauma (Spinal Accessory Nerve Palsy after Spinal Adjustment)

Spinal accessory nerve palsy (SANP) is rare and is commonly presented following iatrogenic injury. Their diagnosis is often missed on initial presentation. Injury following blunt trauma is rare, with few cases reported in literature describing blunt-associated SANP and their treatment and recovery. We present and discuss a case of SANP following an aggressive soft tissue adjustment by an uncertified individual that has been responsive to nonsurgical measures over 18 months. We also reviewed the related literature on similar cases that were presented as result of direct pressure on the nerve from soft tissue manipulation or heavy lifting and their outcome following treatment. Chiropractic is generally a safe complimentary medicine and must only be practiced by trained personnel. We found that blunt-caused SANP injuries should initially be treated conservatively as they are likely to respond and recover unlike when presented following invasive trauma accordingly to what we found in literature.

Isolated Spinal Accessory Nerve Palsy from Volleyball Injury

Spinal accessory nerve (SAN) palsy is typically a result of posterior triangle surgery and can present with partial or complete paralysis of the trapezius muscle and severe shoulder dysfunction. We share an atypical case of a patient who presented with SAN palsy following an injury sustained playing competitive volleyball. A 19-year-old right hand dominant competitive volleyball player presented with right shoulder weakness, dyskinesia, and pain. She injured the right shoulder during a volleyball game 2 years prior when diving routinely for a ball. On physical examination she had weakness of shoulder shrug and a pronounced shift of the scapula when abducting or forward flexing her shoulder greater than 90 degrees. Manual stabilization of the scapula eliminated this shift, so we performed scapulopexy to stabilize the inferior angle of the scapula. At 6 months postoperative, she had full active range of motion of the shoulder. SAN palsy can occur following what would seem to be a routine volleyball maneuver. This could be due to a combination of muscle hypertrophy from intensive volleyball training and stretch sustained while diving for a ball. Despite delayed presentation and complete atrophy of the trapezius, a satisfactory outcome was achieved with scapulopexy.

Isolated Mononeuropathy From Rucksack Palsy: A Case Series

Although there is increasing awareness of brachial plexopathy secondary to rucksack use, isolated mononeuropathies have been less well described. Three cases of mononeuropathy secondary to rucksack use in military personnel are presented, including injuries to the long thoracic and spinal accessory nerves. We also review several different factors in the proper construction, components, and fitting of the rucksack that should be considered in order to prevent rucksack palsy and provide a concise suggestion for rucksack use and education.

Comprehensive Review of Rock Climbing Injuries

Increasing numbers of people are participating in the sport of rock climbing, and its growth is expected to continue with the sport's Olympic debut in 2020. Extreme loading of the upper extremities, contorted positioning of the lower extremities, rockfall, and falling from height create an elevated and diverse injury potential that is affected by experience level and quantity of participation. Injuries vary from acute traumatic injuries to chronic overuse injuries. Unique sport-specific injuries to the flexor tendon pulley system exist, but the remaining musculoskeletal system is not exempt from injury. Orthopaedic evaluation and surgery is frequently required. Understanding the sport of rock climbing and its injury patterns, treatments, and prevention is necessary to diagnose, manage, and counsel the rock-climbing athlete.

Gender, BMI and side-to-side differences in spinal accessory nerve conduction from the upper and middle components of the trapezius muscle

INTRODUCTION

There is a variety of testing methods described in the literature for the spinal accessory nerve (SAN). This study aims to evaluate side-to-side, gender, and BMI differences with surface recording from the upper and middle trapezius using a standard distance to the upper trapezius.

METHODS

Subjects underwent bilateral SAN conduction testing with the active recording electrodes over the superior border of the upper trapezius, midway between the acromion and the C7 spinous process, and over the middle trapezius 3 cm medial to the vertebral border of the scapula.

RESULTS

Mean latency values were 2.17 ± 0.22 msec and 3.14 ± 0.40 msec for the upper and middle trapezius, respectively. Mean amplitude values were 8.02 ± 2.2 mV for the upper trapezius and 3.96 ± 1.77 mV for the middle trapezius. The mean side-to-side latency difference was 7.8% for the upper and 9.5% for the middle trapezius, while the mean side-to-side amplitude difference was 18.2% for the upper and 37.6% for the middle trapezius. BMI had a significant inverse effect on upper and middle trapezius amplitudes such that both males and females with lower BMI had larger amplitudes. There was a significant gender difference for upper and middle trapezius latency with faster latency values observed in females.

CONCLUSIONS

SAN conduction with surface recording from the upper and middle trapezius is well tolerated. Side-to-side differences may be the best way to evaluate both amplitude and latency, so bilateral testing is essential in light of anatomical variation and BMI effects on amplitude.

Unsafe workout: a weak and painful shoulder in a professional volleyball player

A 29-year-old professional volleyball player started complaining of a dull ache in the right lateral base of the neck. This pain arose during a preseasonal athletic training intense session. After 3 days, he presented deficiency of right scapula adduction, limitation of scapula elevation, right shoulder weakness and local mild pain. He had asymmetrical neckline with drooping of the affected shoulder, lateral displacement and minimal winging of the right scapula. After 1 week, hypothrophy of superior trapezius appeared. An electromyography of right upper limb showed a denervation in the upper, middle and lower components of the right trapezius muscle, due to axonotmesis of spinal accessory nerve (SAN). A subsequent MRI was consistent with muscular suffering caused by early denervation. This case shows idiopathic SAN palsy, likely secondary to an inappropriate use of a weight-lifting machine, where the athlete recovered after an adequate rest and rehabilitation period.

Spinal Accessory Nerve Injury Induced by Manipulation Therapy: A Case Report

Spinal accessory nerve (SAN) injury mostly occurs during surgical procedures. SAN injury caused by manipulation therapy has been rarely reported. We present a rare case of SAN injury associated with manipulation therapy showing scapular winging and droopy shoulder. A 42-year-old woman visited our outpatient clinic complaining of pain and limited active range of motion (ROM) in right shoulder and scapular winging after manipulation therapy. Needle electromyography and nerve conduction study suggested SAN injury. Physical therapy (PT) three times a week for 2 weeks were prescribed. After a total of 6 sessions of PT and modality, the patient reported that the pain was gradually relieved during shoulder flexion and abduction with improved active ROM of shoulder. Over the course of 2 months follow-up, the patient reported almost recovered shoulder ROM and strength as before. She did not complain of shoulder pain any more.