Abstract:

Paralysis of trapezius muscle results from spinal accessory nerve injury. Injuries of spinal accessory nerve are a rare condition and it is usually iatrogenic. Cervical lymph node biopsy in the posterior triangle region is one of the reasons that led to this situation. Our case is 16 year old male who was admitted to our outpatient clinic because of right shoulder pain and shoulder asymmetry. Three months ago, a biopsy has been performed from posterior region because of right cervical lymphadenopathy. Physical examination revealed depressed right shoulder, upper trapezius muscle atrophy, downward and outward displaced scapula, and winged scapulae; sternocleidomastoid muscle examination was normal and right shoulder movements were full and painful in all directions. In electromyography, chronic axon damage was seen in the branch of accessory nerve innervating the trapezius muscle following the sternocleidomastoideus muscle. The patient was included in the rehabilitation program. In clinical follow up, the patient's shoulder pain completely resolved and trapezius muscle atrophy was significantly improved. Six months after, the spinal accessory nerve electromyography showed improvement. This case report was presented because of the importance of keeping the spinal accessory nerve palsy in mind in the differential diagnosis of the patients admitting with shoulder pain and/or muscle atrophy and especially when there is a history of previous neck surgery.

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