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Rehabilitation Practice and Science

Translated Title

頸部淋巴結切片手術後脊副神經損傷引起肩頸部疼痛及疑似硬塊：病例報告

Abstract

Shoulder problems such as pain, weakness, limited range of motion and palpable mass are common complaints in PM&R clinic. This casereport describes a less common but not rare condition: iatrogenic accessory nerve injury after neck lymph node biopsy. The patient in this study presented symptoms of shoulder girdle pain and weakness and also complained of a ”hard palpated mass” over her shoulder girdle.A 49-year-old female complained of gradually worsening left shoulder pain accompanied by weakness and limited range of motion in her left shoulder for many months. She had sought medical advice for many times and rotator cuff pathology was diagnosed and treated, but her symptoms had no amelioration. She also complained of a hard immovable mass 2.5 cm in diameter palpated over her left shoulder girdle. She had received a lymph node biopsy six months previously at a different clinic. Physical examination revealed scapular asymmetry and winging. Active range of left shoulder abduction and flexion was reduced due to weakness. Passive range of motion was preserved. Musculoskeletal sonography confirmed the contour of her rotator cuff was intact, and no abnormal mass was observed. The nodule was actually the superior angle of the scapula. Downward rotation had caused protrusion and palpation of the superior angle under soft tissue. Electromyography demonstrated active denervation in the left accessory neuropathy. The final diagnosis was iatrogenic accessory nerve injury contributing to trapezius muscle dysfunction. This disorder is prone to misdiagnosis or delayed diagnosis. This article describes the clinical presentation, diagnosis and treatment of the disorder as well as the biomechanical impact on shoulder girdle and scapula of trapezius dysfunction.

Language

Traditional Chinese

First Page

223

Last Page

228

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