Ann Rehabil Med.  2018 Oct;42(5):773-776. 10.5535/arm.2018.42.5.773.

Spinal Accessory Nerve Injury Induced by Manipulation Therapy: A Case Report

• Yoon JR
• Kim YK
• Ko YD
• Yun SI
• Song DH
• Chung ME

• KMID: 2429207
• DOI: http://doi.org/10.5535/arm.2018.42.5.773

Abstract

Spinal accessory nerve (SAN) injury mostly occurs during surgical procedures. SAN injury caused by manipulation therapy has been rarely reported. We present a rare case of SAN injury associated with manipulation therapy showing scapular winging and droopy shoulder. A 42-year-old woman visited our outpatient clinic complaining of pain and limited active range of motion (ROM) in right shoulder and scapular winging after manipulation therapy. Needle electromyography and nerve conduction study suggested SAN injury. Physical therapy (PT) three times a week for 2 weeks were prescribed. After a total of 6 sessions of PT and modality, the patient reported that the pain was gradually relieved during shoulder flexion and abduction with improved active ROM of shoulder. Over the course of 2 months follow-up, the patient reported almost recovered shoulder ROM and strength as before. She did not complain of shoulder pain any more.

Keyword

Spinal accessory nerve; Manipulation

MeSH Terms

Accessory Nerve Injuries*
Accessory Nerve*
Adult
Ambulatory Care Facilities
Electromyography
Female
Follow-Up Studies
Humans
Musculoskeletal Manipulations*
Needles
Neural Conduction
Range of Motion, Articular
Shoulder
Shoulder Pain

Figure

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  Fig. 1. Cervical magnetic resonance imaging revealing herniated nucleus pulposus in C4-5 and C5-6.

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  Fig. 2. (A) Normal ranges of onset latency and amplitude of compound muscle action potential (CMAP) in the left upper trapezius muscle. (B) Delayed onset latency and decreased amplitude of CMAP in the right upper trapezius muscle.

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