(1)
Department of Neurosurgery, University of Wisconsin, Madison, WI, USA
2.1 Case Presentation
A 64-year-old male underwent left shoulder melanoma resection and cervical lymph node resection 7 months ago. Postoperatively, he noticed weakness, loss of muscle bulk, and decreased range of motion of the left shoulder. There is aching and discomfort but no sensory loss. PMH is significant for urinary bladder carcinoma and basal cell carcinoma, both fully treated.
Fig. 2.1
2.2 Questions
- 1.
What is the most likely diagnosis?
- 2.
What tests are needed?
- 3.
What is the plan of treatment?
Answers
- 1.
Left spinal accessory n injury . Fig. 2.1A, B . Left scapular winging is more pronounced with the elbows flexed (A). This is typical for winging caused by trapezius weakness. Also note left trapezius atrophy. (C) Scars from melanoma resection (1) and lymph node resection (2). (D) The patient has a weak shoulder shrug on the left. (E) He is unable to raise the left arm beyond 90°. The injury probably occurred during lymph node resection (incision 2 in Fig. 2.1C )
- 2.
EMG : Trapezius denervation with no motor units. US : Accessory n seen in continuity with thickened areas that are hypoechoic [1].Related posts:
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