Original article
Spinal accessory nerve in a trapezius-splitting surgical approach

https://doi.org/10.1016/S1058-2746(05)80007-2Get rights and content

To elucidate the safe limits for muscle-splitting incisions of the trapezius muscle, 25cadaver shoulders were studied. To describe the position of the nerve distances were expressed as a percentage of the distance from the tips of the vertebral spinous processes to the lateral tip of the acromion. The spinal accessory nerve was found to run a vertical course medial and parallel to the vertebral border of the scapula. Three to six nerve branches (average 3.8) also ran a vertical course lying between 33% to 50% of the distance from the tips of the vertebral spinous processes to the lateral tip of the acromion. The most lateral branch lay on average at 44% distance and never beyond 50%. Muscle-splitting incisions are relatively safe in the lateral 50% of the muscle. In the medial half they are to be avoided or pursued with great caution.

References (6)

  • BurkheadWZ et al.

    Surgical anatomy of the axillary nerve

    J Shoulder Elbow Surg

    (1992)
  • FlatowEL et al.

    An anatomic study of the musculocutaneous nerve and its relationship to the coracoid process

    Clin Orthop

    (1989)
  • GramykK et al.

    Suprascapular nerve entrapment: a case report with discussion of the anatomy and surgical approaches

    Contemp Orthop

    (1993)
There are more references available in the full text version of this article.

Cited by (14)

  • Arthroscopic release of proximal supra-scapular nerve entrapment: Medium-term results

    2021, Revista Espanola de Cirugia Ortopedica y Traumatologia
  • MRI findings of spinal accessory neuropathy

    2016, Clinical Radiology
    Citation Excerpt :

    In addition, the anatomical course can be variable as it forms a network with the cervical plexus from which it receives contributions.1 The nerve proper gives off one or more small branches to the upper trapezius before coursing ventral to the muscle, finally dividing into 3–6 terminal branches to supply the middle and lower trapezius.14 Imaging the SAN is challenging due to its small diameter (<1–2 mm) and oblique course through the intermuscular fat planes of the neck.

  • Gross Anatomy of the Shoulder

    2016, Rockwood and Matsen’s The Shoulder
  • Nerve Problems Related to the Shoulder

    2016, Rockwood and Matsen’s The Shoulder
  • Quantification of the learning curve for arthroscopic suprascapular nerve decompression: An evaluation of 300 cases

    2015, Arthroscopy - Journal of Arthroscopic and Related Surgery
    Citation Excerpt :

    In addition, this line B was used as a medial limiting line. No portal was created beyond this line to avoid injury to the spinal accessory nerve, which runs medial to the intersecting line between the vertebral spinous processes and the lateral tip of the acromion.24 Thus, in this procedure, line B was drawn with a sufficient safety margin.

  • Current Status of Brachial Plexus Reconstruction: Restoration of Hand Function

    2011, Clinics in Plastic Surgery
    Citation Excerpt :

    Improvement in shoulder function is directly related to the number of shoulder-specific nerve transfers performed.23,32,33 The posterior trapezius approach was initially described to avoid injury to the SAN when decompressing the SSN at the suprascapular notch.34 A similar surgical approach has been described to harvest the maximum length of the descending branch of the SAN.35–38

View all citing articles on Scopus
View full text