Spinal Accessory Nerve Damage

There are 12 pairs of cranial nerves that lead directly from the brain to various parts of the head and neck. The Spinal Accessory Nerve is the 11^th nerve pair and is primarily responsible for movements of the muscles of the upper shoulders, head, neck, pharynx and larynx. The two main muscles supplied by the spinal accessory nerve are the trapezius and the sternocleidomastoid. When the trapezius muscle is weak or paralysed the scapula (shoulder blade) is unstable and flares out or ‘wings'. Other symptoms include:

• Inability to rotate the head away from the affected side
• Drooping of the shoulder
• Localised shoulder and neck pain
• Limitation in range of movements of arm and shoulder including difficulty raising arm above the head.
• Increased risk of developing a frozen shoulder

Damage to the spinal accessory nerve can be a result of certain vigorous athletic activities but it more commonly occurs during surgical intervention in the neck area-

• Dissection of a tumour
• Removal of lymph nodes
• Insertion of cannula into carotid artery
• Removal of clot from carotid artery (carotid endarterectomy)

Microsurgical reconstruction of a severed spinal accessory nerve if often successful if the interval between the trauma and the surgical revision is less than 6 months. Up to 12months a partial recovery can be achieved.

Physiotherapy can also be very beneficial considerably improving the range of arm and neck movements.

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