Spinal Accessary Nerve Injury

Updated 3/2017--all links removed as many no longer active. 

This injury will never result in an individual qualifying for SSI disability.  Not even when it occurs on the side of  your dominant hand.  That doesn’t mean it isn’t a serious problem and can result in significant shoulder dysfunction and pain.  It simply means it will never “meet” an SSI disability listing and will not result in more than a one-arm light RFC (residual functional capacity) rating. 

The spinal accessary nerve  supplies the sternocleidomastoid (SCM) and trapezius muscles.  So when the nerve is injured your ability to rotate, tilt, flex your head may be impaired (SCM).  Your ability to elevate your shoulder and draw your head back so the face is upward may also be impaired (trapezius muscle involvement).  The shoulder may exhibit a winged scapula which may be more apparent or exaggerated on arm abduction.

Causes of SAN injury include iatrogenic, traumatic, and neurologic. 

Most iatrogenic SAN injury occur following diagnostic lymph node biopsies of the posterior triangle of the neck. Injury rates from these procedures are reportedly 3-8%.   Functional neck dissections are another source of iatrogenic SAN injury.

As with other nerve injuries, if the injury is a transection and is recognized it can be repaired.  This may be done immediately or within 3 to 6 months after the injury. 

If it is uncertain if this nerve was indeed cut or is a closed injury (ie trauma), then close follow-up with serial electrical tests helps determine if surgery will be required. Physical therapy is the mainstay of treatment regardless of whether surgery is indicated. It improves range of motion and encourages a return of strength once contraction occurs.

Nerve regeneration can take 3-12 months, during which time physical therapy is performed. Patients with a spinal accessory nerve injury older than 1-2 years may not be a candidate for nerve surgery.  So the sooner the injury is recognized and diagnosed, the better. Options for these patients may include tendon/muscle transfer techniques to stabilize the scapula and reduce pain.

REFERENCES
1.  Cranial Nerve XI: The Spinal Accessory Nerve – Clinical Methods
2.  Accessory Nerve Injury; Rohan Ramchandra Walvekar, MD, et al; eMedicine, July 20, 2010
3.  Spinal Accessory Nerve Injury; NYU Medical Center

Kids and Boxing

I can’t say I am a fan of boxing, but I can appreciate the discipline required both mentally and physically.  The American Academy of Pediatrics has recently (full reference below, free access) issued a policy statement on participation of children and adolescents in the sport of boxing (bold emphasis is mine).

Thousands of boys and girls younger than 19 years participate in boxing in North America. Although boxing provides benefits for participants, including exercise, self-discipline, and self-confidence, the sport of boxing encourages and rewards deliberate blows to the head and face. Participants in boxing are at risk of head, face, and neck injuries, including chronic and even fatal neurologic injuries. Concussions are one of the most common injuries that occur with boxing. Because of the risk of head and facial injuries, the American Academy of Pediatrics and the Canadian Paediatric Society oppose boxing as a sport for children and adolescents. These organizations recommend that physicians vigorously oppose boxing in youth and encourage patients to participate in alternative sports in which intentional head blows are not central to the sport.

I would tend to agree that children should be encouraged to participate in sports that have less risk of concussion injury.

Related posts:
Cauliflower Ear  (September 21, 2007)
Mangled Ear--a badge of honor?  (August 4, 2008)
Hematoma of Ear (Boxer's Ear) – 1908 TX  (October 14, 2009)


REFERENCES

Policy Statement—Boxing Participation by Children and Adolescents; American Academy of Pediatrics, Council on Sports Medicine and Fitness, Canadian Paediatric Society, and Healthy Active Living and Sports Medicine Committee; Pediatrics 2011; peds.2011-1165; published ahead of print August 28, 2011, doi:10.1542/peds.2011-1165

Frontline's Football High

Updated 3/2017-- video and all links removed as many no longer active. 

With high school football season upon us, Frontline reran their show “Football High.”  It features two Arkansas football players who suffered heat stroke last year (one survived, one did not).  There is also a good discussion of other injuries, particularly concussions, among high school football athletes.  Here is a preview but it can be watched in it’s entirety here. 

There is more info here on Frontline’s website.

Shout Outs

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. 

Dr. John Schumannis, Glass Hospital, the host for this week’s Grand Rounds.   You can read this week’s edition here.

Hope you had a wonderful holiday weekend.

GlassHospital is proud to host this week’s Grand Rounds, a compendium of medical-related writing and blogging from around the world. This week’s theme, in honor of the holiday, is CELEBRATION. Here at GH we’re pleased to be celebrating the six month anniversary of our debut.

We have 21 pieces to share with you, including one poem and one photo. This week’s submissions, all celebratory-themed, seemed to cluster into five main categories: Aging gracefully, history & literature, medical drama, health care policy, and good ol’ humor. So pull up a chair, maybe a nice iced coffee, and dig in………..

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Here are a few of many injuries in the news due to fireworks.:
N.Y. man loses arm in fireworks blast
Man seriously injured in fireworks accident at Cross Lake
Colo. Springs man injured by homemade fireworks
Children injured by fireworks brought to hospital
Girl Hurt in Fireworks Accident in Platte City
3 Hurt In Blue Springs Fireworks Accident

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I am not a fan of guns, but my husband is.  He doesn’t hunt, but collects antique guns (Civil War Era) and has a concealed carry permit.  It is with interest that I have been following the news story on gun rights vs public safety.  NPR has done a nice job of covering this:  High Court Ruling Fuels Chicago's Handgun Debate

Twice in two years, the U.S. Supreme Court has struck down handgun bans in major American cities.

More On Gun Rulings

Some D.C. Residents Say It's Too Hard To Get A Gun July 5, 2010

The first ruling two years ago overturned a gun law in Washington, D.C. The second high court decision, which came last week, involved a similar statute in Chicago.

The City Council quickly changed the law — and it is now legal to own a handgun in the Windy City.

Gun rights advocates say Chicago residents will be safer from violent crime. But those advocating gun control say the opposite: that guns in the home put more people at risk………….

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As I have seen many injuries due to power saws, I paid close attention to this NPR story:  Sharp Edge: One Man's Quest To Improve Saw Safety

Table saws are by far the most dangerous tools used by woodworkers and do-it-yourself enthusiasts. Every year around the U.S., more than 3,000 people cut off their fingers or thumbs in table saw accidents, according to data from the Consumer Product Safety Commission. And 30,000 end up in emergency rooms with other injuries.

One entrepreneur has developed a safety device called SawStop that prevents those injuries. But the power tool industry has chosen not to adopt the technology. And because of that, power tool manufacturers now face a growing number of lawsuits………

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Brendan Marracco’s story is told by Lizette Alvarez in the New York Times:  Spirit Intact, Soldier Reclaims His Life

……..In the nearly 15 months since, Specialist Marrocco has pushed past pain and exhaustion to learn to use his four prosthetics, though he can walk for only 15 minutes at a time. He has met sports stars like Jorge Posada and Tiger Woods — and become something of a star himself here at Walter Reed Army Medical Center, where his moxie and humor are an inspiration to hundreds of other wounded service members. He has also met, fallen in love with and proposed marriage to a young woman who sees what is there rather than what is missing, though Specialist Marrocco has lately been questioning the relationship……….

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Dr Anonymous’ BTR show will be on summer break until late August.

Upcoming shows (9pm ET)

Jul-Aug: Summer Break
8/26: Dr. A Show 3rd Anniversary