This study from Paris reviewed the results of patients treated with trapezius palsy, either with nerve reconstruction or an Eden-Lange muscle transfer. The etiology of the spinal accessory nerve injury was surgical dissection of a cervical mass in 21 patients, radical neck dissection in two patients and a direct penetrating injury by glass in one. Three patients had spontaneous paralysis without a history of injury. All patients had stiffness, pain and weakness of the shoulder girdle. All patients reported weakness in the shoulder girdle that was accentuated by prolonged use of the arm and all were limited in their abilities to perform overhead activities and to lift heavy objects. Active abduction of the shoulder averaged 78 degrees (range, 30 to 140 degrees). There were two nerve repairs, ten neurolyses, eight nerve grafting procedures (average length of the graft, 4.5 cm) and seven patients treated with the Eden-Lange muscle transfer which lateralizes the levator scapulae, rhomboideus major and minor. The average age at the time of the operation was 38 years (range 15-75 years). The interval before nerve surgery averaged seven months (range, 2 to 20 months) and that before the reconstructive surgery averaged 28 months (range, 6 to 84 months). The median duration of follow up was 26 months (range, 12-140 months). Of the 20 patients treated with nerve surgery, 80 % had a good or excellent result. Of the two patients treated with neurorrhaphy, one had an excellent result and one had a good result. Of the ten treated with neurolysis, four had an excellent result, four had a good result, and two had a poor result. The average active shoulder abduction was 126 degrees + 31 degrees. In the group undergoing the Eden-Lange tendon transfer, three were graded as excellent, one as good and three with poor results. The average range of active shoulder abduction was 120 degrees + 40 degrees. Factors that were predictive of a poor result were patient age over 50 years, spinal accessory lesion caused by a radical neck dissection, penetrating injury or spontaneous palsy.
The vast majority of these patients sustained a spinal accessory nerve injury during a lymph node biopsy or radical dissection. Very acceptable results were obtained with nerve reconstruction up to 20 months post nerve injury. This most likely reflects the short distance required for the spinal accessory nerve to reinnervate the trapezius muscle. Therefore, in patients with a trapezius palsy secondary to spinal accessory nerve injury, nerve reconstruction even up to 20 months may be indicated. Overall, the results of nerve repair, neurolysis or grafting was overall greater than that of tendon transfers. However, in patients who are greater than 20 months from the time of injury or who do not recover from primary nerve reconstruction may be candidates for muscle tendon transfers to reconstruct the stability about the scapula.
Journal of Bone and Joint Surgery