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Background and Aims Patient after a fall with right craniofacial-cervical trauma. Diagnosed with cervical spine straightening and C5-C6 disc protrusion. Reports persistent left cervicobrachialgia. Studies reveal left humeral tuberosity fracture and tendinitis. Despite rehabilitation, referred to pain consultation due to symptom persistence.
Methods Physical examination shows atrophy of the left trapezius and sternocleidomastoid muscles, along with reduced strength in the upper and middle trapezius (figure 1). Post-vaccination Parsonage-Turner syndrome or accessory spinal nerve injury is considered. Electromyography reveals moderate to severe partial axonotmesis of the left accessory spinal nerve (figure 2). Magnetic resonance imaging shows extensive neuropathy along the nerve pathway (figure 3). The patient receives conservative treatment with analgesics, corticosteroids, pregabalin, clonazepam, and intensive rehabilitation. Significant improvement in pain and muscular recovery is observed at 6 weeks. Electromyography at 8 weeks demonstrates increased amplitude of the motor evoked potential, indicating progressive and adequate reinervation. In conclusion, accessory spinal nerve injuries are uncommon after mild trauma and are typically associated with oncological surgery. Initial treatment should be conservative, considering surgical options only if conservative treatment fails. Additionally, the use of platelet-rich plasma may hold promise in the treatment of such injuries. Comprehensive physical examination and appropriate ancillary tests are essential for accurate diagnosis and proper management, as pathological imaging does not always explain clinical findings.
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