Spinal accessory neuropathy, droopy shoulder, and thoracic outlet syndrome.
Droopy shoulder has been proposed as a cause of thoracic outlet syndrome. Two patients developed manifestations of neurovascular compression upon arm abduction, associated with unilateral droopy shoulder and trapezius muscle weakness caused by iatrogenic spinal accessory neuropathies following cervical lymph node biopsies. The first patient developed a cold, numb hand with complete axillary artery occlusion when his arm was abducted to 90 degrees. The second patient complained of paresthesias in digits 4 and 5 of the right hand, worsened by elevation of the arm, with nerve conduction findings of right lower trunk plexopathy (low ulnar and medial antebrachial cutaneous sensory nerve action potentials). Spinal accessory nerve grafting (in the first patient) coupled with shoulder strengthening physical exercises in both patients resulted in gradual improvement of symptoms in 2 years. These two cases demonstrate that unilateral droopy shoulder secondary to trapezius muscle weakness may cause compression of the thoracic outlet structures.
Al-Shekhlee
Amer
A
Neuromuscular Division , Department of Neurology, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Hanna Building, Fifth Floor, Cleveland, Ohio 44106-5040, USA. amer.alshekhlee2@uhhs.com
Katirji
Bashar
B
D000055:Accessory Nerve / Q000503:physiopathology; D020436:Accessory Nerve Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D061227:Accessory Nerve Injuries; D000328:Adult; D001366:Axillary Artery / Q000293:injuries / Q000503:physiopathology; D001917:Brachial Plexus / Q000293:injuries / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D018908:Muscle Weakness / Q000150:complications* / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D009431:Neural Conduction / Q000502:physiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D011859:Radiography; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects*; D012782:Shoulder / Q000000981:diagnostic imaging / Q000294:innervation / Q000503:physiopathology; D013901:Thoracic Outlet Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology