What are indications for surgical management of a spinal accessory nerve (SAN) injury?

Updated: Dec 08, 2020
  • Author: Rohan R Walvekar, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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The decision to undergo surgical intervention in the absence of an obvious nerve injury or resection should be made only after sequential evaluations following the initial trauma fail to show spontaneous improvement in trapezius muscle function and confirm stable neurologic deficits.

Indications for surgical management are as follows: [14]

  • Dense paralysis

  • Absence of clinical or electrophysiologic improvement on serial examinations

  • Distressing subjective symptoms, pain or severe scapulohumeral dysfunction

  • Intraoperative identification of a nerve-in-continuity that does not show contractions on direct stimulation (nerve resection and reconstruction should be considered.) [38]

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