Spinal accessory nerve (SAN) injury after lipoma resection presenting as shoulder pain
The ubiquity of shoulder pain necessitates familiarity with its diverse differential including peripheral nerve injury. This case illustrates the need for physiatrists to consider the SAN particularly with isolated trapezius weakness after ipsilateral neck surgery. The SAN exits the jugular foramen into the posterior triangle of the neck, crossing anterior to the jugular vein to innervate the SCM and trapezius. The trapezius contributes to scapular retraction and upward rotation. Thus, injury can lead to significant disability. Surgical repair is challenging and introduces risk. Therefore, it is crucial to meticulously identify deficits to be addressed with physical therapy and bracing to optimize scapulothoracic stability.
Arline Edmond– Resident Physician, Rutgers NJMS/Kessler Institute of Rehabilitation
Jason Bitterman– Resident Physician, Rutgers NJMS/Kessler Institute of Rehabilitation
Rex Ma– Clinical Assistant Professor/Attending Physician, VA New Jersey Health Care System/Rutgers-NJMS
Gautam Maholtra– Clinical Assistant Professor/Attending Physician, VA New Jersey Health Care System/Rutgers NJMS