Spinal Accessory Nerve Injury

Total Page：16

File Type：pdf, Size：1020Kb

VIDEO CASE SOLUTION VIDEO CASE SOLUTION Spinal Accessory Nerve Injury BY AZIZ SHAIBANI, MD, FACP, FAAN, FANA In last month’s case challenge, I presented a case of a 37-year-old woman who had a cervical lymph node biopsy three months earlier and presented with pain and stiffness of the right upper back muscles that did not respond to gabapentin. She developed tingling of the right little fingers a couple of weeks earlier. A chiropractic manipulation gave her temporary relief. SPINAL ACCESSORY NERVE INJURY The patient is suffering from spinal accessory nerve (SAN) injury. Here is further information about SAN injury1: • The trapezius stabilizes the base of the scapula. • It originates from the spinous processes of the cervical and thoracic vertebrae and inserts into the spine of the scapula. • The spinal accessory nerve (SAN) branches from the third and fourth cervical roots. • Surgical procedures in the posterior triangle of the neck can cause injury to the SAN due to its superficial location in that region. • Patients rarely notice the winged scapula and they usually present with periscapular pain and stiffness. • Scapular winging is lateral. The scapula deviates laterally, unlike the medial winging seen in long thoracic neuropathy. • Proximal lesion leads to sternocleidomastoid weakness, as well. • Depression of the shoulder is an important diagnostic clue. • Shoulder droop may lead to thoracic outlet syndrome (TOS). This explains why the patient later developed little finger numbness. Typically, in neurogenic TOS there is a reduction of the ipsilateral ulnar SNAP and median CMAP. • On nerve conduction studies, stimulation of the right SAN did not produce a motor response. (By comparison, the ampli- tude of the left CMAP was 6mV). • Needle examination showed active denervation changes in the right trapezius. Needle EMG of the right rhomboid and ser- ratus anterior was normal. • Surgical options include: Transfer of the levator scapula to the spine of the scapula, which has been reported to result in return of function and relief of pain. 1. Bigliani LU, Compito CA, Duralde XA, Wolfe IN. Transfer of levator scapulae, rhomboid major, and rhomboid minor for paralysis of the trapezius. J Bone Joint Surg Am. 1996 Oct; 78(10): 1534-40. OCTOBER 2015 PRACTICAL NEUROLOGY 49 .

Copy Link

Recommended publications

Examination of the Shoulder Bruce S
Examination of the Shoulder Bruce S. Wolock, MD Towson Orthopaedic Associates 3 Joints, 1 Articulation 1. Sternoclavicular 2. Acromioclavicular 3. Glenohumeral 4. Scapulothoracic AC Separation Bony Landmarks 1. Suprasternal notch 2. Sternoclavicular joint 3. Coracoid 4. Acromioclavicular joint 5. Acromion 6. Greater tuberosity of the humerus 7. Bicipital groove 8. Scapular spine 9. Scapular borders-vertebral and lateral Sternoclavicular Dislocation Soft Tissues 1. Rotator Cuff 2. Subacromial bursa 3. Axilla 4. Muscles: a. Sternocleidomastoid b. Pectoralis major c. Biceps d. Deltoid Congenital Absence of Pectoralis Major Pectoralis Major Rupture Soft Tissues (con’t) e. Trapezius f. Rhomboid major and minor g. Latissimus dorsi h. Serratus anterior Range of Motion: Active and Passive 1. Abduction - 90 degrees 2. Adduction - 45 degrees 3. Extension - 45 degrees 4. Flexion - 180 degrees 5. Internal rotation – 90 degrees 6. External rotation – 45 degrees Muscle Testing 1. Flexion a. Primary - Anterior deltoid (axillary nerve, C5) - Coracobrachialis (musculocutaneous nerve, C5/6 b. Secondary - Pectoralis major - Biceps Biceps Rupture- Longhead Muscle Testing 2. Extension a. Primary - Latissimus dorsi (thoracodorsal nerve, C6/8) - Teres major (lower subscapular nerve, C5/6) - Posterior deltoid (axillary nerve, C5/6) b. Secondary - Teres minor - Triceps Abduction Primary a. Middle deltoid (axillary nerve, C5/6) b. Supraspinatus (suprascapular nerve, C5/6) Secondary a. Anterior and posterior deltoid b. Serratus anterior Deltoid Ruputure Axillary Nerve Palsy Adduction Primary a. Pectoralis major (medial and lateral pectoral nerves, C5-T1 b. Latissimus dorsi (thoracodorsal nerve, C6/8) Secondary a. Teres major b. Anterior deltoid External Rotation Primary a. Infraspinatus (suprascapular nerve, C5/6) b. Teres minor (axillary nerve, C5) Secondary a.
[Show full text]
Stichting Voor Ooglijders Prof. Dr. HJ
De publicatie van dit proefschrift werd mede mogelijk gemaakt met fmanciele steun van: Stichting voor Ooglijders Prof. Dr. H.J. Flieringa Stichting Medical Workshop BV Kabi Pharmacia Bournonville-Pharma BV Ter herinnering aan mijn vader Omslag: Henry Cannon I Ebbo Clerlo: CLINICAL ASPECTS AND ETIOLOGY OF FUCHS' HETEROCHROMIC CYCLITIS (KLINISCHE ASPECTEN EN ETIOLOGIE VAN DE HETEROCHROME CYCLITIS VAN FUCHS) proefschrift Ter verkrijging van de graad van doctor aan de Erasmus Universiteit Rotterdam op gezag van de Rector Magnificus Prof. dr. P.W.C. Akkermans M. Lit. en volgens besluit van het College van Dekanen. De openbare verdediding zal plaatsvinden op woensdag 3 November 1993 om 15.45 uur. door Ellen Carolien La Heij geboren te Arnstelveen PROMOTIE-COMMISSIE PROMOTORES' Prof. dr. P.T.V.M. de Jong Prof. dr. A. Kijlstra OVERIGE LEDEN, Prof. dr. F.T. Bosman Prof. dr. H.A. Drexhage CONTENTS Chapter 1 1.1 General Introduction ........................ 7 1. 2 Aim of the Thesis_ ................... __ ...... 8 Chapter 2 Fuchs' Heterochromic Cyclitis: Review of the Literature (submitted for publication) 2.1 Historical Background ........................ 9 2.2 Terminology and Classification ............... 9 2. 3 Epidemiology. .11 2. 4 Clinical Features ........................... 11. 2.5 Histopathology of the Iris ................. 22 2. 6 Etiologic Mechanisms ........................ 25 2.7 Therapy and Prognosis .................... ... 37 Chapter 3 Clin~c~l analysis of Fuchs' heterochromic cycl1t1s ........................................ 49 (Doc Ophthalmol. 1991;78:225-235). Chapter 4 Treatment and prognosis of secondary glaucoma in Fuchs' heterochromic cyclitis ............... .... 61 (Am J Ophthalmol. 1993, in press) Chapter 5 Quantitative analysis of iris translucency in Fuchs' heterochromic cyclitis ................. .. 83 (Invest Ophthalmol & Vis Sci.
[Show full text]
Orphanet Report Series Rare Diseases Collection
Marche des Maladies Rares – Alliance Maladies Rares Orphanet Report Series Rare Diseases collection DecemberOctober 2013 2009 List of rare diseases and synonyms Listed in alphabetical order www.orpha.net 20102206 Rare diseases listed in alphabetical order ORPHA ORPHA ORPHA Disease name Disease name Disease name Number Number Number 289157 1-alpha-hydroxylase deficiency 309127 3-hydroxyacyl-CoA dehydrogenase 228384 5q14.3 microdeletion syndrome deficiency 293948 1p21.3 microdeletion syndrome 314655 5q31.3 microdeletion syndrome 939 3-hydroxyisobutyric aciduria 1606 1p36 deletion syndrome 228415 5q35 microduplication syndrome 2616 3M syndrome 250989 1q21.1 microdeletion syndrome 96125 6p subtelomeric deletion syndrome 2616 3-M syndrome 250994 1q21.1 microduplication syndrome 251046 6p22 microdeletion syndrome 293843 3MC syndrome 250999 1q41q42 microdeletion syndrome 96125 6p25 microdeletion syndrome 6 3-methylcrotonylglycinuria 250999 1q41-q42 microdeletion syndrome 99135 6-phosphogluconate dehydrogenase 67046 3-methylglutaconic aciduria type 1 deficiency 238769 1q44 microdeletion syndrome 111 3-methylglutaconic aciduria type 2 13 6-pyruvoyl-tetrahydropterin synthase 976 2,8 dihydroxyadenine urolithiasis deficiency 67047 3-methylglutaconic aciduria type 3 869 2A syndrome 75857 6q terminal deletion 67048 3-methylglutaconic aciduria type 4 79154 2-aminoadipic 2-oxoadipic aciduria 171829 6q16 deletion syndrome 66634 3-methylglutaconic aciduria type 5 19 2-hydroxyglutaric acidemia 251056 6q25 microdeletion syndrome 352328 3-methylglutaconic
[Show full text]
Dorsal Scapular Nerve Neuropathy: a Narrative Review of the Literature Brad Muir, Bsc.(Hons), DC, FRCCSS(C)1
ISSN 0008-3194 (p)/ISSN 1715-6181 (e)/2017/128–144/$2.00/©JCCA 2017 Dorsal scapular nerve neuropathy: a narrative review of the literature Brad Muir, BSc.(Hons), DC, FRCCSS(C)1 Objective: The purpose of this paper is to elucidate Objectif : Ce document a pour objectif d’élucider this little known cause of upper back pain through a cette cause peu connue de douleur dans le haut du narrative review of the literature and to discuss the dos par un examen narratif de la littérature, ainsi que possible role of the dorsal scapular nerve (DSN) in de discuter du rôle possible du nerf scapulaire dorsal the etiopathology of other similar diagnoses in this (NSD) dans l’étiopathologie d’autres diagnostics area including cervicogenic dorsalgia (CD), notalgia semblables dans ce domaine, y compris la dorsalgie paresthetica (NP), SICK scapula and a posterolateral cervicogénique (DC), la notalgie paresthésique (NP), arm pain pattern. l’omoplate SICK et un schéma de douleur postéro- Background: Dorsal scapular nerve (DSN) latérale au bras. neuropathy has been a rarely thought of differential Contexte : La neuropathie du nerf scapulaire dorsal diagnosis for mid scapular, upper to mid back and (NSD) constitue un diagnostic différentiel rare pour la costovertebral pain. These are common conditions douleur mi-scapulaire, costo-vertébrale et au bas/haut presenting to chiropractic, physiotherapy, massage du dos. Il s’agit de troubles communs qui surgissent therapy and medical offices. dans les cabinets de chiropratique, de physiothérapie, de Methods: The methods used to gather articles for this massothérapie et de médecin. paper included: searching electronic databases; and Méthodologie : Les méthodes utilisées pour hand searching relevant references from journal articles rassembler les articles de ce document comprenaient la and textbook chapters.
[Show full text]
Board Review for Anatomy
Board Review for Anatomy John A. McNulty, Ph.D. Spring, 2005 . LOYOLA UNIVERSITY CHICAGO Stritch School of Medicine Key Skeletal landmarks • Head - mastoid process, angle of mandible, occipital protuberance • Neck – thyroid cartilage, cricoid cartilage • Thorax - jugular notch, sternal angle, xiphoid process, coracoid process, costal arch • Back - vertebra prominence, scapular spine (acromion), iliac crest • UE – epicondyles, styloid processes, carpal bones. • Pelvis – ant. sup. iliac spine, pubic tubercle • LE – head of fibula, malleoli, tarsal bones Key vertebral levels • C2 - angle of mandible • C4 - thyroid notch • C6 - cricoid cartilage - esophagus, trachea begin • C7 - vertebra prominence • T2 - jugular notch; scapular spine • T4/5 - sternal angle - rib 2 articulates, trachea divides • T9 - xiphisternum • L1/L2 - pancreas; spinal cord ends. • L4 - iliac crest; umbilicus; aorta divides • S1 - sacral promontory Upper limb nerve lesions Recall that any muscle that crosses a joint, acts on that joint. Also recall that muscles innervated by individual nerves within compartments tend to have similar actions. • Long thoracic n. - “winged” scapula. • Upper trunk (C5,C6) - Erb Duchenne - shoulder rotators, musculocutaneous • Lower trunk (C8, T1) - Klumpke’s - ulnar nerve (interossei muscle) • Radial nerve – (Saturday night palsy) - wrist drop • Median nerve (recurrent median) – thenar compartment - thumb • Ulnar nerve - interossei muscles. Lower limb nerve lesions Review actions of the various compartments. • Lumbosacral lesions - usually
[Show full text]
Scapular Winging Secondary to Apparent Long Thoracic Nerve Palsy in a Young Female Swimmer
THIEME Case Report e57 Scapular Winging Secondary to Apparent Long Thoracic Nerve Palsy in a Young Female Swimmer Shiro Nawa1 1 Department of Judo Seifuku and Health Sciences, Faculty of Health Address for correspondence Shiro Nawa, MS, Department of Judo Promotional Sciences, Tokoha University, Hamamatsu City, Seifuku and Health Sciences, Faculty of Health Promotional Sciences, Shizuoka-ken, Japan Tokoha University, 1230 Miyakoda-cho, Kita-ku, Hamamatsu City, Shizuoka-ken, 431-2102, Japan J Brachial Plex Peripher Nerve Inj 2015;10:e57–e61. (e-mail: [email protected]). Abstract Background In neurological diseases, winging of the scapula occurs because of serratus anterior muscle dysfunction due to long thoracic nerve palsy, or trapezius muscle dysfunction due to accessory nerve palsy. Several sports can cause long thoracic nerve palsy, including archery and tennis. To our knowledge, this is the first report of long thoracic nerve palsy in an aquatic sport. Objective The present study is a rare case of winging of the scapula that occurred during synchronized swimming practice. Methods The patient’s history with the present illness, examination findings, rehabili- tation progress, and related medical literature are presented. Keywords Results A 14-year-old female synchronized swimmer had chief complaints of muscle ► winging of the weakness, pain, and paresthesia in the right scapula. Upon examination, marked scapula winging of the scapula appeared during anterior arm elevation, as did floating of the ► accessory nerve palsy superior angle. After 1 year of therapy, right shoulder girdle pain and paresthesia had ► long thoracic nerve disappeared; however, winging of the scapula remained. palsy Conclusions Based on this observation and the severe pain in the vicinity of the second ► synchronized dorsal rib, we believe the cause was damage to the nerve proximal to the branch arising swimming from the upper nerve trunk that innervates the serratus anterior.
[Show full text]
Occupational Shoulder.Pdf
ORIGINAL PAPER International Journal of Occupational Medicine and Environmental Health 2021;34(3):427 – 435 https://doi.org/10.13075/ijomeh.1896.011634 OCCUPATIONAL SHOULDER DISABILITY: FUNCTIONAL RECOVERY AFTER DECOMPRESSION AND NEUROLYSIS OF THE UPPER BRACHIAL PLEXUS AND THE LONG THORACIC NERVE RAHUL K. NATH, ALYSSA M. LEAL, and CHANDRA SOMASUNDARAM Texas Nerve and Paralysis Institute, Houston, USA Research Division Abstract Objectives: This study aimed to assess the surgical outcomes of patients with work-related upper extremity musculoskeletal disorders (UE-MSDs) who failed conservative treatment. Material and Methods: This was a retrospective study of 17 patients who had work-related UE-MSDs and under- went the following surgeries and follow-up evaluations: decompression, external and internal neurolysis of the upper trunk of the brachial plexus and the long thoracic nerve (LTN), and a partial resection of the anterior and middle scalene muscle. A detailed history of clinical presentation including pain, physical and clinical examinations of the extent of scapular winging (ESW), and upper extremity anatomical postures, such as active forward arm flexion and shoulder abduction, were recorded before and after 3 months of the surgery. Nerve conduction velocity and electromyography exami- nation reports were obtained to assess the sensory or motor loss of the nerve injury before their operation. Results: All 17 patients included in this report showed some improvement anatomically in the scapula appearance and functionally in their shoulder movements. More specifically, 9 (53%) patients got a restored to near healthy appearance of the scapula, and 11 (65%) patients recovered a full range of motion, 180° post-surgically. Over- all, the mean shoulder flexion and abduction improved to 157±37.5° and 155±40.2° after the surgery from 106±30.2° and 111±34.8°, respectively (p < 0.0001).
[Show full text]
Winged Scapula
r e v b r a s o r t o p . 2 0 1 5;5 0(5):573–577 www.rbo.org.br Artigo Original Síndrome do aprisionamento fascial do nervo ଝ torácico longo: escápula alada a,b c,∗ b,d Jefferson Braga Silva , Samanta Gerhardt e Ivan Pacheco a Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil b Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brasil c Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brasil d Instituto de Medicina do Esporte, Hospital Mãe de Deus, Porto Alegre, RS, Brasil informações sobre o artigo r e s u m o Histórico do artigo: Objetivo: Analisar os resultados de cirurgia de intervenção precoce em pacientes com sín- Recebido em 1 de julho de 2014 drome do aprisionamento fascial do nervo torácico longo e consequente escápula alada. Aceito em 16 de setembro de 2014 Métodos: Acompanhamos seis pacientes com uma síndrome de aprisionamento sem On-line em 24 de dezembro de 2014 restrições específicas de estiramento ao nervo. Resultados: Pacientes tiveram melhoria em seus sintomas seis a 20 meses após o proce- Palavras-chave: dimento. Sintomas motores melhoraram completamente sem qualquer dor persistente. A Escápula deformidade medial da escápula alada melhorou em todos os casos sem distúrbios estéticos Tórax residuais. Síndromes de compressão nervosa Conclusão: A abordagem de liberação cirúrgica precoce parece ser um melhor preditor na recuperação de paralisia não traumática do músculo serrátil anterior.
[Show full text]
336 Naegeli's
336 INDEX N Naegeli's Narrowing - continued - disease 287.1 - artery NEC - continued - leukemia, monocytic (M9863/3) 205.1 -- cerebellar 433.8 Naffziger's syndrome 353.0 -- choroidal 433.8 Naga sore (see also Ulcer, skin) 707.9 -- communicative posterior 433.8 Nagele's pelvis 738.6 -- coronary 414.0 - with disproportion 653.0 --- congenital 090.5 -- causing obstructed labor 660.1 --- due to syphilis 093.8 -- fetus or newborn 763.1 -- hypophyseal 433.8 Nail - see also condition -- pontine 433.8 - biting 307.9 -- precerebral NEC 433.9 - patella syndrome 756.8 --- multiple or bilateral 433.3 Nanism, nanosomia (see also Dwarfism) -- vertebral 433.2 259.4 --- with other precerebral artery 433.3 - pituitary 253.3 --- bilateral 433.3 - renis, renalis 588.0 auditory canal (external) 380.5 Nanukayami 100.8 cerebral arteries 437.0 Napkin rash 691.0 cicatricial - see Cicatrix Narcissism 302.8 eustachian tube 381.6 Narcolepsy 347 eyelid 374.4 Narcosis - intervertebral disc or space NEC - see - carbon dioxide (respiratory) 786.0 Degeneration, intervertebral disc - due to drug - joint space, hip 719.8 -- correct substance properly - larynx 478.7 administered 780.0 mesenteric artery (with gangrene) 557.0 -- overdose or wrong substance given or - palate 524.8 taken 977.9 - palpebral fissure 374.4 --- specified drug - see Table of drugs - retinal artery 362.1 and chemicals - ureter 593.3 Narcotism (chronic) (see also Dependence) - urethra (see also Stricture, urethra) 598.9 304.9 Narrowness, abnormal. eyelid 743.6 - acute NEC Nasal- see condition correct
[Show full text]
Parsonage-Turner Syndrome Following Post-Exposure Prophylaxis Duncan P Fransz1, Casper P Schönhuth1*, Tjeerd J Postma2 and Barend J Van Royen1
Fransz et al. BMC Musculoskeletal Disorders 2014, 15:265 http://www.biomedcentral.com/1471-2474/15/265 CASE REPORT Open Access Parsonage-Turner syndrome following post-exposure prophylaxis Duncan P Fransz1, Casper P Schönhuth1*, Tjeerd J Postma2 and Barend J van Royen1 Abstract Background: The ‘Parsonage-Turner syndrome’ (PTS) is a rare but distinct disorder with an abrupt onset of shoulder pain, followed by weakness and atrophy of the upper extremity musculature, and a slow recovery requiring months to years. To our best knowledge, this is the first case describing symptoms and signs of PTS following the administration of a post-exposure prophylaxis (PEP) regimen against possible human immunodeficiency virus (HIV) and hepatitis B virus (HBV) infection. Case presentation: A 25-year-old Caucasian man presented with pain and unilateral scapular winging following PEP against possible HIV and HBV infection. Although atrophy and weakness were observed for the right supraspinatus muscle, a full range of motion was achievable. Neurological examination, plain radiography of the right shoulder and electromyography showed no additional abnormalities. The patient was diagnosed with post-vaccination PTS and treated non-operatively. During the following 15 months the scapular winging receded and full muscle strength was regained. Conclusion: Parsonage-Turner syndrome is a rare clinical diagnosis. The precise pathophysiological mechanism of PTS remains unclear, but it seems to involve an interaction between genetic predisposition, mechanical vulnerability and an autoimmune trigger. An immunological event, such as – in this case – a vaccination as part of PEP treatment, can trigger the onset of PTS. The clinical presentation is distinctive with acute severe pain followed by patchy paresis, atrophy and sensory symptoms that persist for months to years.
[Show full text]
Report from the Department of Justice
Report from the Department of Justice June 3, 2016 Catharine E Reeves Acting Deputy Director, Torts Branch 1 Statistics Reporting Period: 2/16/15 – 5/15/16 I. Total Petitions Filed in the United States Court of Federal Claims this reporting period: 206 A. Minors: 38 B. Adults: 168 2 Statistics Reporting Period: 2/16/15 – 5/15/16 II. Total Petitions Adjudicated this reporting period: 225 A. Compensated: 176 i. Cases conceded by HHS: 61 1. Decision awarding damages: 1 2. Decision adopting Proffer: 59 3. Decision adopting Settlement: 1 ii. Cases not conceded by HHS: 115 1. Decision awarding damages: 0 2. Decision adopting Proffer: 0 3. Decision adopting Settlement: 115 B. Not Compensated/Dismissed: 49 i. Decision dismissing Non-OAP: 46 ii. Decision dismissing OAP: 3 3 Statistics Cont. Reporting Period: 2/16/15 – 5/15/16 III. Total Petitions Voluntarily Withdrawn this reporting period (no judgment will be issued): 9 4 Appeals: U.S. Court of Appeals for the Federal Circuit Recently Decided Cases Appeals by Petitioner: Padmanabhan v. HHS (Entitlement): Affirmed per curiam Petitioners filed a combined petition for panel rehearing and en banc hearing Moriarty v. HHS (Entitlement): Vacated, Remanded D’ Angiolini v. HHS (Entitlement): Affirmed Greenberg v. HHS (Entitlement): Affirmed per curiam Appeals by Respondent: Guerrero v. HHS (Attorneys' Fees and Costs): Voluntarily Dismissed All decisions are available on the CAFC’s website: http://www.cafc.uscourts.gov 5 Appeals: U.S. Court of Appeals for the Federal Circuit Pending Cases Appeals by Petitioner: Mora v. HHS (Relief from Judgment) Nutall v. HHS (Entitlement) Contreras v.
[Show full text]
The Utility of Ultrasound in the Assessment of Traumatic Peripheral Nerve Lesions: Report of 4 Cases
NEUROSURGICAL FOCUS Neurosurg Focus 39 (3):E3, 2015 The utility of ultrasound in the assessment of traumatic peripheral nerve lesions: report of 4 cases Joshua Zeidenberg, MD,1 S. Shelby Burks, MD,2 Jean Jose, DO,1 Ty K. Subhawong, MD,1 and Allan D. Levi, MD, PhD2 1Department of Radiology, University of Miami/Jackson Memorial Hospital; and 2Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida Ultrasound technology continues to improve with better image resolution and availability. Its use in evaluating peripheral nerve lesions is increasing. The current review focuses on the utility of ultrasound in traumatic injuries. In this report, the authors present 4 illustrative cases in which high-resolution ultrasound dramatically enhanced the anatomical under- standing and surgical planning of traumatic peripheral nerve lesions. Cases include a lacerating injury of the sciatic nerve at the popliteal fossa, a femoral nerve injury from a pseudoaneurysm, an ulnar nerve neuroma after attempted repair with a conduit, and, finally, a spinal accessory nerve injury after biopsy of a supraclavicular fossa lesion. Preop- erative ultrasound images and intraoperative pictures are presented with a focus on how ultrasound aided with surgical decision making. These cases are set into context with a review of the literature on peripheral nerve ultrasound and a comparison between ultrasound and MRI modalities. http://thejns.org/doi/abs/10.3171/2015.6.FOCUS15214 KEY WORDS ultrasound; peripheral nerves; tibial nerve; peroneal nerve; ulnar nerve; spinal accessory nerve ERIPHERAL nerve injuries can be classified according combination of neurological examination and EMG is in- to their location, mechanism of injury, and com- sufficient for determining the precise extent of nerve dam- pleteness of injury.
[Show full text]