• See Also
  1. Peripheral Nerve Injury
  2. Cranial Nerve 11
  • Anatomy
  1. Spinal Accessory nerve (CN 11) is vulnerable to injury at the posterior triangle of the neck
  • Causes
  1. Trapezius Trauma
  2. Shoulder Dislocation
  3. Nerve injury during surgical procedures
    1. Radical neck dissection
    2. Cervical node biopsy
    3. Carotid endarterectomy
  • Symptoms
  1. Generalized Shoulder Pain
  2. Shoulder weakness
  • Signs
  1. Shoulder sags on affected side
  2. Shoulder weak on shrugging
  3. Forward flexion at Shoulder weak overhead
  4. Trapezius atrophy (with longstanding injury)
  • Management
  1. Physical Therapy
  2. Avoid provocative activities
  3. Surgery is rarely indicated
    1. Consider surgery for Penetrating Trauma with nerve transection
    2. Consider surgery for lack of improvement at 18 to 24 months
  • References
  1. Neal (2010) Am Fam Physician 81(2): 147-55 [PubMed]
  2. Safran (2004) Am Sports Med 32(4): 1063-76 [PubMed]
  3. Silver (2021) Am Fam Physician 103(5): 275-85 [PubMed]