Impairment of upper trapezius branch of the spinal accessory nerve during bypass grafting: A stretch injury?

Abstract

Internal jugular vein catheterization has been implicated in spinal accessory nerve (SAN) injuries after coronary artery bypass grafting (CABG). Stretch injury due to prolonged positioning during CABG has also been proposed as another mechanism of injury. Herein we describe a male patient with left shoulder pain and abduction difficulty following CABG, who displayed electromyographic abnormalities confined to the left upper trapezius muscle. Internal jugular vein catheterization had not been performed during surgery. Although unusual, the possibility of upper trapezius muscular branch paralysis should be considered in patients with shoulder pain or weakness after CABG.

Complex Scapular Winging following Total Shoulder Arthroplasty in a Patient with Ehlers-Danlos Syndrome

“…The modified Eden-Lange procedure, which can correct lateral scapular winging from trapezius deficiency [ 40 , 58 – 60 ], was not performed because (1) spontaneous improvement in trapezius strength was considered likely [ 26 , 27 ] and (2) the patient's hyperextensible collagenous tissues would increase the probability that this procedure would fail. We initially expected spontaneous improvement because the association of SAN with our patient's index TSA resembled case reports where SAN occurred in association with open-heart surgery [ 26 , 27 ]. In these cases the SAN was likely caused by pressure/strength injuries from positioning during the surgery or by a complication of internal jugular vein cannulation (this was not done on our patient) [ 61 – 63 ].…”

“…Additionally, a fluoroscopic-guided aspiration of the right shoulder revealed no evidence of infection. His opinion was to (1) observe the scapular winging [ 25 – 27 ] and (2) perform revision shoulder surgery to manually lyse adhesions and revise the humeral prosthesis to reduce its overall vertical “height” in order to correct “overstuffing” ( Figure 2 ).…”

“…The patient was informed that active motion above 90° would be difficult, if not impossible, to achieve without stability of the pectoral girdle during dynamic shoulder motion [ 38 – 40 ]. The plan was to continue to observe the trapezius palsy because of the likelihood that it would spontaneously improve to an acceptable level of strength [ 25 – 27 ]. If the scapular winging did not spontaneously improve by 18 to 24 months after the index TSA, then the plan was to restore the deficient trapezius with a modified Eden-Lange procedure [ 25 , 40 ].…”

Spinal accesory nerve blockade by local infiltration for central venous catheter insertion: An unusual occurrence

“…[2] In our case, use of posterior approach, higher volume of LA, and Trendelenberg position causing LA to gravitate may have contributed to the blockade of SAN. Injury to SAN using the posterior approach has been mentioned previously in two reports,[34] but here direct trauma by needle had been implicated.…”

Kanat Skapula: Bir Etyoloji, İki Farklı Sinir

“…12). Bu çalışmada sunulan iki olguda da etiyolojik nedenler incelendiğinde uzun süreli tiroid operasyonu dikkati çekmektedir.…”