title: Conservative treatment for late-diagnosed spinal accessory nerve injury.
abstract: OBJECTIVE
  Spinal accessory nerve (SAN) injuries cause considerable shoulder joint dysfunction and pain, but are often underdiagnosed or diagnosed late. The aim of this study was to present the clinical and electrophysiological features and response to conservative treatment of the patients with late-diagnosed SAN injury.
  
  
  METHODS
  Nine patients diagnosed with SAN injury based on clinical and electrophysiological examinations were evaluated. All patients were treated with a standard physical therapy and rehabilitation program and then received home exercise program. Shoulder pain during rest and activity and pain causing sleep disturbances were evaluated using a visual analog scale. Constant scale investigated shoulder function. Shoulder disability questionnaire evaluated daily living activities. Results were assessed before treatment, after one month of treatment, and years after treatment.
  
  
  RESULTS
  According to the electrophysiological studies, seven patients had partial and two patients had total axonal SAN injuries. The delay from the time of injury to diagnosis ranged between 12 and 84 mo (median 14 mo). When compared with the baseline values, visual analog scale, Constant scale, and shoulder disability questionnaire scores were significantly improved in all of the patients.
  
  
  CONCLUSIONS
  For patients with late-diagnosed SAN injury, conservative treatment seems to be an effective treatment option.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey.
authors.forename: Kenan
authors.initials: K
authors.lastname: Akgun
authors.forename: Ilknur
authors.initials: I
authors.lastname: Aktas
authors.forename: Kayihan
authors.initials: K
authors.lastname: Uluc
mesh_terms: D061227:Accessory Nerve Injuries; D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D004576:Electromyography; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D020069:Shoulder Pain / Q000209:etiology / Q000534:rehabilitation*; D011795:Surveys and Questionnaires