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Year |
2001 |
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Question Number |
148. |
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Category |
Select |
Question
A 32-year-old man notes a lump on the side of his neck and undergoes a lymph node biopsy. Following the procedure, the patient reports pain in the shoulder girdle and is unable to elevate his shoulder. Which of the following structures has most likely been injured?
1. trapezius muscle
2. sternocleidomastoid muscle
3. axillary nerve
4. cranial nerve XI
5. suprascapular nerve
Figures
Answer (click for answer)
The answer is 4. The injured structure described is the spinal accessory nerve (cranial nerve XI.) The spinal accessory nerve leaves the jugular foramen at the base of the skull and passes obliquely through the sternomastoid muscle in its upper third and then across the posterior triangle of the neck to the trapezius. It is the major nerve supply of the trapezius muscle. Because of its superficial location, it is at risk for injury during minor surgical procedures, such as a lymph node biopsy. Injury to the spinal accessory nerve presents clinically as weakness in shoulder shrug and pain with abduction of the arm.
Reference: Leffert, R. "Neurologic Problems," in C. Rockwood and F. Matsen The Shoulder, 1998, pp. 974-976