|
|
Spinal accessory nerve
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
Spinal accessory nerve - June 6, 2008 8:14:33 PM
|
|
|
KAK
Posts: 202
Joined: December 1, 2004
Status: offline
|
Any experience/words of wisdom on treating a patient whose spinal accessory nerve has been sacrificed during cervical lymph node excision? Obviously there will always be dysfunction, but what can be done to maximize function and minimize pain without a functioning trapezius? Specifically, I am interested in exercises and ADL education. Thanks!
|
|
|
|
|
RE: Spinal accessory nerve - June 9, 2008 11:17:53 AM
|
|
|
Shill
Posts: 1107
Joined: February 13, 2003
From: Madison WI USA
Status: offline
|
They can expect up to about 140 degrees of function in the scapular plane, for flexion/scaption for reaching. I see a lot of these patients, and this is the best reach I have seen. ABDuction will be fairly painful and not beyond 90. As you mentioned, nothing can make up for the rotation of the scapula that traps provides, but I still have patients do some prone scapular exercises, just for the sake of trying to reeducate other muscles to help as much as is possible. Passive scapular elevation as a "rescue" position is rather helpful, as it takes off the mechanical pain created by nerve stretch from the lack of resting tone in the traps. Teaching the patient to sit in a chair with the arm passively supported in scapular elevation is something the patients really appreciate to help them in times of pain. Radiation and radiation fibrosis often accentuates the pain symptoms quite a bit as well. Keeping the neck moving during and after this process is crucial, including neck extension, which is often overlooked. Depending on what was done with the vessels, you may need to be careful due to alterred anatomy, and fibrosis near the vessels, so watch for VBI like symptoms of pupil changes during any neck extension. Dizziness is not necessarily a contraindication to extending in these folks, but visual changes and pupil constriction/dilation differences are....however, some of these folks are on narcotics for pain meds, so they will have small pupils to begin with. feel free to email me for more specifics, if you wish.
< Message edited by Shill -- June 9, 2008 11:22:31 AM >
_____________________________
Steve Hill PT
|
|
|
|
|
RE: Spinal accessory nerve - June 10, 2008 5:16:02 AM
|
|
|
KAK
Posts: 202
Joined: December 1, 2004
Status: offline
|
Shill,
Thank you! That is very helpful! Since a section of the nerve was removed, I imagine there is minimal (if any) chance of reinnervation. Am I correct in this?
|
|
|
|
|
RE: Spinal accessory nerve - June 10, 2008 6:55:54 AM
|
|
|
apolipo
Posts: 115
Joined: December 22, 2004
From: Grand Rapids, MI
Status: offline
|
Three things I would definetely work on are:
- GH caudal glide
- RC strength
- RC neuromuscular control
All to avoid impingement as much as can be done. Shill made a good point about excessive strain on the UT. I have treated pts. like this with passive scapular superior glide mobs to help relieve strain. However, this was in pts. with intact neural function whom were also working on UT strengthening. It is likely that the levator scap will become irritable from overwork, which could lead to occipital pain and headaches. Educate the pt. about good cervicoscapular posture and re-emphasize the need to find a rest position as often as can be done.
Mike T
P.S. - no, there won't be any return of function if a portion of the nerve was removed.
|
|
|
|
|
RE: Spinal accessory nerve - June 10, 2008 11:07:04 AM
|
|
|
Shill
Posts: 1107
Joined: February 13, 2003
From: Madison WI USA
Status: offline
|
Kak,
There is essentially no chance for return of the nerve that is removed, as apolipo mentioned.
|
|
|
|
|
RE: Spinal accessory nerve - June 11, 2008 6:32:17 AM
|
|
|
KAK
Posts: 202
Joined: December 1, 2004
Status: offline
|
That is what I thought, but the patient insisted that the Dr. told him it might take a year for recovery. This is not a case of neuropraxia or axonotmesis; the surgeon clearly told me he “sacrificed” the nerve. Maybe it was the referring doctor (an endocrinologist) who told him that. Thank you both for your help!
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.109
|
Printable Version
