Accessory nerve injury and entrapment
Introduction
Introduction to accessory nerve injury and compression The vast majority of accessory nerve injuries are surgical accidental injuries. Once damaged, the trapezius muscles become paralyzed, causing certain deformities and severe dysfunction. basic knowledge The proportion of sickness: 0.012% - 0.015% Susceptible people: no special people Mode of infection: non-infectious Complications: muscle atrophy
Cause
Paraneoplastic injury and the cause of compression
the reason
Paraneoplastic injury is mainly caused by surgical injury in the posterior triangle of the neck, especially in the lymph node biopsy of the posterior triangle of the neck. Occasionally, it is reported that the neck impact injury, open injury or cervical triangle surgery caused damage, Seddon reported 14 cases of accessory nerve In the injury, 8 cases suffered from posterior cervical triangulation injury, and 6 cases were caused by open neck injury. Among the 17 cases reported in China, 14 cases were lymph node biopsy of the posterior triangle, 1 case was resected posterior triangle, and 2 cases were resected. For the fall injury, the 6 cases handled by the author were caused by the posterior cervical lymph node biopsy.
Pathogenesis
The accessory nerve is the XI pair of cranial nerves, which are composed of cranial nerves and spinal nerve roots. The spinal cord roots are from the lateral bundles of the anterior and posterior roots of the neck 1 to the neck 5, and the cranial nerve roots are accompanied by the vagus nerve. The nerve trunk, which passes through the cervical intervertebral foramen and walks with the internal jugular vein, spans the external jugular vein, reaches the sternocleidomastoid muscle, and the nerve passes through the midpoint of the sternocleidomastoid muscle, and the branch branches to the muscle. After the midpoint of the sternocleidomastoid muscle is worn out, the accessory nerve enters the lateral triangle of the neck. Between the anterior fascia and the superficial fascia, the trapezius muscle is slanted downward to the inner surface of the trapezius muscle, and the lower third of the trapezius muscle. It is dominated by the branch of the cervical nerve. In the outer triangle of the neck, the accessory nerve and the neck are shallow, the vein and the lymph node are adjacent. A variety of factors can cause the accessory nerve to be crushed or damaged, such as the skull base tumor compression, the congenital anomaly at the neck joint, and the skull base. Fractures, cervical lymph node biopsy and surgery can also cause paraneoplastic damage.
Prevention
Paraneoplastic injury and compression prevention
As long as the surgery is fully exposed, the anatomical relationship is clear, prevent blind clamping, ligation or cutting, do not pull too heavy or form a hematoma, surgical injury of the accessory nerve can be completely avoided, when the lymph node biopsy is performed in the posterior triangle area, as much as possible Operate in areas other than nerves. If you must remove lymph nodes in this area, you should enlarge the incision and expose the nerves before removing the lymph nodes to avoid damage to the accessory nerves.
Complication
Paraneoplastic injury and compression complications Complications muscle atrophy
The disease belongs to surgical injury. Once damaged, the trapezius muscle will be paralyzed, causing certain deformities and severe dysfunction, such as muscle atrophy, physics, numbness and other complications.
Symptom
Paraneoplastic injury and compression symptoms Common symptoms Shoulder involvement pain Progressive muscle paralysis shoulder muscles, upper limbs and... Inability to dull pain
1. The accessory nerve is compressed or damaged. The shoulder abduction can not exceed 90°. This is because the trapezius muscle paralysis, the muscle strength of the scapula is lowered, the weight of the upper limb rotates the scapula, and the lower scapula moves inward. The inner upper corner is moved outward, and the joint face is turned downward, which limits the movement of the shoulder joint.
2. The trapezius muscle atrophy, and the scapula levator muscle attached to the upper inner corner of the scapula is contracted, which improves the position of the upper scapula of the scapula, and the posterior margin of the supraclavicular fossa is increased, and the supraclavicular fossa is obviously deepened.
3. The affected side shrugs and shoulders.
4. Some patients present with dull shoulder pain and radiate to the arm.
Examine
Paraneoplastic injury and compression check
EMG and nerve transit velocity check.
Diagnosis
Diagnosis of accessory nerve injury and compression
1. History: There is often a history of trauma or a history of neck surgery.
2. Clinical manifestations: shoulder discomfort, weakness or pain, difficulty in shrugging, lifting shoulders below 90°, sagging shoulders, feeling of pulling, atrophy of trapezius muscles, etc.
3. Trapeziral paralysis: The most helpful auxiliary examination is electromyography and nerve conduction velocity examination. The trapezius muscle, sternocleidomastoid muscle and muscles that may be used for metastasis should be examined - lifting the scapula and large and small. For the rhomboid muscle, the chest long nerve and the anterior serratus muscle should also be examined, because if the anterior serratus paralysis is accompanied, the surgical effect will be affected. Regular EMG follow-up can understand the recovery after the accessory nerve is damaged, and it also helps. Decided to use neuroprobe or tendon transfer.
