Subject(s)
Accessory Nerve Diseases/etiology , Accessory Nerve Diseases/rehabilitation , Accessory Nerve Injuries , Rhytidoplasty/adverse effects , Accessory Nerve Diseases/diagnosis , Aged , Electromyography , Female , Follow-Up Studies , Humans , Pain Measurement , Physical Examination , Physical Therapy Modalities , Recovery of Function , Rhytidoplasty/methods , Risk Assessment , Severity of Illness Index , Shoulder Pain/etiology , Shoulder Pain/physiopathology , Shoulder Pain/rehabilitation , Treatment OutcomeABSTRACT
Isolated spinal accessory nerve palsy after coronary artery bypass graft (CABG) surgery is a rare complication. We report a case of a 52-yr-old male patient who presented with right shoulder weakness, drooping of shoulder, and weakness of forward elevation after CABG. A program of neuromuscular electrical stimulation and exercises was started after the diagnosis of right isolated spinal accessory nerve palsy by physical examination and electromyographic study. Involved muscle function recovered after 6 mos of physical therapy and rehabilitation. This case report suggests that isolated spinal accessory nerve palsy should be considered in cases of shoulder pain or weakness after CABG, and conservative treatment is recommended if palsy develops.
Subject(s)
Accessory Nerve Diseases/etiology , Accessory Nerve Diseases/rehabilitation , Coronary Artery Bypass/adverse effects , Muscle Weakness/etiology , Physical Therapy Modalities , Shoulder Pain/etiology , Accessory Nerve Diseases/diagnosis , Electric Stimulation Therapy , Electromyography , Humans , Male , Middle AgedABSTRACT
CONCLUSIONS: Occupational therapy significantly improves shoulder range of motion in patients with accessory nerve palsy after radical neck dissection, but it has limited effects on the associated pain. OBJECTIVE: To evaluate the outcome of occupational therapy rehabilitation for patients with accessory nerve palsy. PATIENTS AND METHODS: The occupational therapy group involved 35 shoulders of 29 patients with accessory nerve palsy after radical neck dissection; the control group included 10 shoulders of 9 patients who did not receive occupational therapy. All patients had a malignant tumor in the head or neck that necessitated radical neck dissection. We collected data pertaining to resting pain, motion pain, and the active and passive range of motion during shoulder flexion and abduction. RESULTS: Occupational therapy did not adequately relieve resting or motion pain, but all patients achieved independence in activities of daily living and housekeeping activities. Although occupational therapy significantly improved shoulder elevation for all movements, shoulder elevation was significantly better for flexion than for active and passive abduction.
Subject(s)
Accessory Nerve Diseases/rehabilitation , Accessory Nerve Injuries , Neck Dissection , Occupational Therapy , Otorhinolaryngologic Neoplasms/surgery , Postoperative Complications/rehabilitation , Shoulder/innervation , Activities of Daily Living/classification , Adult , Aftercare , Aged , Female , Humans , Isometric Contraction/physiology , Male , Middle Aged , Nerve Regeneration/physiology , Pain Measurement , Range of Motion, ArticularABSTRACT
The subjects in this study were ten patients with accessory nerve palsy after radical neck dissection. All the primary diseases that accounted for radical neck dissection were malignant tumors located at the head or neck. Every patient received occupational therapy and underwent evaluations before and after the therapy. The data we collected included the existence of resting pain and motion pain, and the active and passive range of motion during shoulder flexion and abduction. The occupational therapy programs were not adequately effective for resting and motion pain, however, every patient gained independence for activities of daily living and housekeeping activities. The occupational therapy significantly improved the patient's shoulder elevation in all movements; although, the active abduction was always significantly poor compared with flexion. In the meantime, there were no significant differences between passive shoulder flexion and abduction at all times. We can therefore understand that the accessory nerve palsy especially affects active shoulder abduction induced by the trapezius paralysis. Occupational therapy is an effective treatment for the improvement of shoulder function, however, the occupational therapy has limited effectiveness for coping with the pain.
Subject(s)
Accessory Nerve Diseases/rehabilitation , Neck Dissection/adverse effects , Occupational Therapy , Accessory Nerve Diseases/etiology , Adult , Aged , Female , Humans , Male , Middle Aged , Pain Management , Postoperative ComplicationsABSTRACT
BACKGROUND AND PURPOSE: The authors found no literature describing adhesive capsulitis as a consequence of spinal accessory nerve injury and no exercise program or protocol for patients with spinal accessory nerve injury. The purpose of this case report is to describe the management of a patient with adhesive capsulitis and spinal accessory nerve injury following a carotid endarterectomy. CASE DESCRIPTION: The patient was a 67-year-old woman referred for physical therapy following manipulation of the left shoulder and a diagnosis of adhesive capsulitis by her orthopedist. Spinal accessory nerve injury was identified during the initial physical therapy examination, and a program of neuromuscular electrical stimulation was initiated. OUTCOMES: The patient had almost full restoration of the involved muscle function after 5 months of physical therapy. DISCUSSION: This case report illustrates the importance of accurate diagnosis and suggests physical therapy intervention to manage adhesive capsulitis as a consequence of spinal accessory nerve injury.
