What are the clinical signs associated with a spinal accessory nerve (SAN) injury?

Updated: Mar 04, 2020
  • Author: Rohan R Walvekar, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Pain around the shoulder and neck can be assessed on a 10-point visual analogue scale (VAS). The mean intensity associated with SAN-related shoulder syndrome can average around 7 (range, 6-9). [36]

The affected shoulder is depressed with inferior rotation of the lateral angle of the scapula.

Scapular “winging” can be accentuated by abduction of the arm.

Wasting of the trapezius may be evident in the upper part of the neck. [20]

ROM can be restricted.

  • Active abduction (30°-140° range)

  • Active forward flexion (50°-180° range) [42]

Serial clinical examinations and EMG studies that fail to show an improvement in function is a clinical sign associated with SAN injury.

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