accessory nerve diseases


Summary: Diseases of the eleventh cranial (spinal accessory) nerve. This nerve originates from motor neurons in the lower medulla (accessory portion of nerve) and upper spinal cord (spinal portion of nerve). The two components of the nerve join and exit the skull via the jugular foramen, innervating the sternocleidomastoid and trapezius muscles, which become weak or paralyzed if the nerve is injured. The nerve is commonly involved in MOTOR NEURON DISEASE, and may be injured by trauma to the posterior triangle of the neck.

Top Publications

  1. Chan P, Hems T. Clinical signs of accessory nerve palsy. J Trauma. 2006;60:1142-4 pubmed
    ..We propose that the resisted active external rotation test should be regarded as the key clinical sign for accessory nerve palsy. ..
  2. Omar N, Alvi F, Srinivasan M. An unusual presentation of whiplash injury: long thoracic and spinal accessory nerve injury. Eur Spine J. 2007;16 Suppl 3:275-7 pubmed
    ..Although isolated injuries of both nerves following a whiplash injury have been reported, combined injury of the two nerves following a whiplash injury is very uncommon and is being reported for the first time. ..
  3. Friedenberg S, Zimprich T, Harper C. The natural history of long thoracic and spinal accessory neuropathies. Muscle Nerve. 2002;25:535-9 pubmed
    ..Our data suggest that, contrary to other focal neuropathies, the electrodiagnostic findings do not predict functional outcome in these neuropathies. ..
  4. Delevaux I, Andre M, Marroun I, Lamaison D, Piette J, Aumaitre O. Intractable hiccup as the initial presenting feature of systemic lupus erythematosus. Lupus. 2005;14:406-8 pubmed
    ..Hiccup has withdrew with corticosteroid therapy and low-dose aspirin. The other cases of literature and pathophysiologic hypotheses are briefly reported...
  5. Ozdemir O, Kurne A, Temucin C, Varli K. Spontaneous unilateral accessory nerve palsy: a case report and review of the literature. Clin Rheumatol. 2007;26:1581-3 pubmed
    ..Herein, we present a patient with a diagnosis of spontaneous spinal accessory nerve palsy, which was rarely reported in the relevant literature. ..
  6. Ho T, Samuel P, Jeannon J, McElroy J. Malignant peripheral nerve sheath tumour of the spinal accessory nerve. J Laryngol Otol. 1999;113:942-4 pubmed
    ..Histological examination of the surgical specimen showed features in keeping with a malignant peripheral nerve sheath tumour (MPNST). We present the clinical and pathological features of this condition. ..
  7. Sander H, Saadeh P, D Alessandri C, Chokroverty S. Trapezius CMAP amplitude asymmetry in accessory neuropathy. Electromyogr Clin Neurophysiol. 1999;39:411-4 pubmed
    ..Middle and lower trapezius side-side CMAP amplitude comparisons may increase the sensitivity of accessory neuropathy electrodiagnosis. ..
  8. Alonso J, Reis R. [Neuropathies of the spinal accessory nerve secondary to cervical surgery: clinical and electrophysiological study of 7 cases]. Arq Neuropsiquiatr. 2000;58:704-12 pubmed
    ..Lesion type is usually axonotmesis, but varied degrees of compression by cicatricial spurs are observed in some patients. Surgical approach and nerve repair must be considered for pacients with delayed recovery. ..
  9. Mao Y, Zhou L, Zhang R. [Jugular foramen schwannomas: a review of 17 cases]. Zhonghua Wai Ke Za Zhi. 2004;42:773-6 pubmed
    ..One patient had facial palsy. JF schwannomas can be surgically treated with relative good outcomes. Surgical approaches should be tailored according to the tumor extension. ..

More Information


  1. Bodner G, Harpf C, Gardetto A, Kovacs P, Gruber H, Peer S, et al. Ultrasonography of the accessory nerve: normal and pathologic findings in cadavers and patients with iatrogenic accessory nerve palsy. J Ultrasound Med. 2002;21:1159-63 pubmed
    ..Ultrasonography allows visualization of the normal accessory nerve as well as changes after accessory nerve palsy. ..
  2. Shimada Y, Chida S, Matsunaga T, Sato M, Hatakeyama K, Itoi E. Clinical results of rehabilitation for accessory nerve palsy after radical neck dissection. Acta Otolaryngol. 2007;127:491-7 pubmed
    ..Although occupational therapy significantly improved shoulder elevation for all movements, shoulder elevation was significantly better for flexion than for active and passive abduction. ..
  3. Tatagiba M, Koerbel A, Bornemann A, Freudenstein D. Meningioma of the accessory nerve extending from the jugular foramen into the parapharyngeal space. Acta Neurochir (Wien). 2005;147:909-10 pubmed
    ..To the knowledge of the authors this is the first report of an accessory nerve meningioma in the jugular foramen associated with a posterior fossa component and extension into the parapharyngeal space. ..
  4. Yoshihara N, Okuda M, Takano K, Wada T, Osaka H. Idiopathic cranial polyneuropathy with unilateral IX and X and contralateral XI nerve palsy in a 4-year-old boy. Pediatr Neurol. 2012;47:198-200 pubmed publisher
    ..We suggest that aggressive therapy is unnecessary for patients with idiopathic cranial polyneuropathy. The pathogenesis of this condition may involve an immunologic mechanism...
  5. Clark A, Chalmers R. Bilateral carotid body tumours presenting with accessory nerve palsy. Eur J Vasc Endovasc Surg. 2002;23:87-8 pubmed
  6. Chida S, Shimada Y, Matsunaga T, Sato M, Hatakeyama K, Mizoi K. Occupational therapy for accessory nerve palsy after radical neck dissection. Tohoku J Exp Med. 2002;196:157-65 pubmed
    ..Occupational therapy is an effective treatment for the improvement of shoulder function, however, the occupational therapy has limited effectiveness for coping with the pain. ..
  7. Salerno G, Cavaliere M, Foglia A, Pellicoro D, Mottola G, Nardone M, et al. The 11th nerve syndrome in functional neck dissection. Laryngoscope. 2002;112:1299-307 pubmed
    ..Physical therapy aimed to early recover passive motion and to avoid the occurrence of joint fibrosis has been shown to have a real contributory role in decreasing shoulder complaints and improving the patients' QOL. ..
  8. Thome C, Grobholz R, Boschert J, Schmiedek P. Bilateral meningiomatous lesions of the spinal accessory nerves. Acta Neurochir (Wien). 2003;145:309-13; discussion 313 pubmed
    ..To the authors' knowledge this is the first report of intradural tumours of the spinal accessory nerves not derived from Schwann cells and the first report of bilateral intracranial meningiomatous lesions without dural attachment. ..
  9. Hatashita S, Mitsuhashi T, Kurosu A, Ueno H. Schwannoma of the spinal accessory nerve--case report. Neurol Med Chir (Tokyo). 2003;43:501-4 pubmed
    ..The tumor was removed by surgery with the involved segment of the nerve. She had no postoperative neurological deficit. Histological examination confirmed the diagnosis of schwannoma. Surgical removal is recommended for such cases. ..
  10. Kadri P, Al Mefty O. Surgical treatment of dumbbell-shaped jugular foramen schwannomas. Neurosurg Focus. 2004;17:E9 pubmed
    ..Furthermore, recovery of function in the affected cranial nerves can be expected. ..
  11. Numanoglu A, Rode H. Cervical lymph node biopsy -- watch the nerves!. S Afr Med J. 2006;96:51-2 pubmed
  12. Seymour F, Lloyd S, Harcourt J. Glomus jugulare tumour presenting with isolated accessory nerve palsy. J Laryngol Otol. 2004;118:234-6 pubmed
    ..Diagnosis is often delayed due to the slow growth of the tumour. We describe the previously unreported occurrence of a glomus tumour presenting with a unilateral accessory nerve palsy. ..
  13. Samii A, Slimp J, Friedly J, Goodkin R. Spinal accessory neuropathy after deep brain stimulation for Parkinson's disease. Stereotact Funct Neurosurg. 2007;85:296-8 pubmed
    ..As a result of this complication, we now map the spinal accessory nerve electrophysiologically during deep brain stimulation surgery. ..
  14. Ong C, Chong V. The glossopharyngeal, vagus and spinal accessory nerves. Eur J Radiol. 2010;74:359-67 pubmed publisher
    ..We present an overview of their anatomy, highlighting the important clinical and imaging implications. The main pathologic lesions arising from these nerves are also discussed and the imaging features reviewed. ..
  15. Sergides N, Nikolopoulos D, Polyzois I. Idiopathic spinal accessory nerve palsy. A case report. Orthop Traumatol Surg Res. 2010;96:589-92 pubmed publisher
    ..There was no related trauma, nor any past history of surgical procedures. An electromyographic study confirmed the idiopathic paralysis of the distal segment of the spinal accessory nerve. ..
  16. Magill C, Moore A, Mackinnon S. Same modality nerve reconstruction for accessory nerve injuries. Otolaryngol Head Neck Surg. 2008;139:854-6 pubmed publisher
    ..These cases provide a stimulus to consider the use of motor nerve grafts or transfers in the repair of motor nerve deficits. ..
  17. Tan E, Lo Y, Thomas J, Chan L. Bilateral trapezius hypertrophy with dystonia and atrophy. CMAJ. 2007;176:1702-3 pubmed
  18. Hacein Bey L, Blazun J, Jackson R. Carotid artery pseudoaneurysm after orthognathic surgery causing lower cranial nerve palsies: endovascular repair. J Oral Maxillofac Surg. 2013;71:1948-55 pubmed publisher
    ..Angiography exquisitely demonstrated the pseudoaneurysm, which was fully repaired with the combination of stenting and coil obliteration, allowing total preservation of the ICA. ..
  19. Lee J, Sy E, Chang C, Chang S. Craniofacial gunshot injury resulting in pseudoaneurysm of the left internal maxillary artery and Collet-Sicard syndrome. J Craniofac Surg. 2009;20:568-71 pubmed publisher
    ..In addition, we describe the clinical course of the rarely occurring Collet-Sicard syndrome, which involves injury to the 9th, 10th, 11th, and 12th cranial nerves associated with gunshot injury. ..
  20. Funakawa I, Terao A, Koga M. [A case of zoster sine herpete with involvement of the unilateral IX, X and XI cranial and upper cervical nerves]. Rinsho Shinkeigaku. 1999;39:958-60 pubmed
    ..Although case reports of unilateral IX, X and XI cranial nerve palsies with ZSH is very rare, ZSH should be kept in mind in the differential diagnosis of multiple cranial nerve palsies. ..
  21. Mohr A, Ebert S, Knauth M. [Spontaneous dissection of the internal carotid artery with ipsilateral Collet-Sicard syndrome]. Rofo. 2006;178:444-6 pubmed
  22. Jary A, Maillard L, Raffo E, Ducrocq X, Braun M, Vespignani H. [Acute, isolated and reversible paralysis of the soft palate in childhood]. Rev Neurol (Paris). 2004;160:836-8 pubmed
    ..Further case reports would be useful to confirm the benign nature of this syndrome so that complementary investigations may be limited in future cases with a similar presentation. ..
  23. Braybrooke J, Kumar C, Morris E. Spinal accessory nerve palsy following blunt trauma. Injury. 2003;34:948-9 pubmed
  24. Bertelli J, Ghizoni M. Combined injury of the accessory nerve and brachial plexus. Neurosurgery. 2011;68:390-5; discussion 396 pubmed publisher
    ..In proximal injuries, the platysma motor branch should be transferred to the accessory nerve; whereas in paralysis distal to the sternocleidomastoid muscle, the accessory nerve should be explored and grafted. ..
  25. Chibbaro S, Mirone G, Makiese O, Bresson D, George B. Dumbbell-shaped jugular foramen schwannomas: surgical management, outcome and complications on a series of 16 patients. Neurosurg Rev. 2009;32:151-9; discussion 159 pubmed publisher
    ..Finally, full cranial nerve functional recovery may be expected after complete resection. ..
  26. Massey E. Spinal accessory nerve lesions. Semin Neurol. 2009;29:82-4 pubmed publisher
  27. Rescigno J, Felice K. Spinal accessory mononeuropathy following posterior fossa decompression surgery. Acta Neurol Scand. 2002;105:326-9 pubmed
    ..To our knowledge, this association has not been previously reported. ..
  28. Chang C, Chang K, Chen Y, Kuo P. Electrophysiologic evidence of spinal accessory neuropathy in patients with cervical myofascial pain syndrome. Arch Phys Med Rehabil. 2011;92:935-40 pubmed publisher
    ..We suggest that spinal accessory neuropathy may be associated with cervical MFPS. ..
  29. Veyseller B, Aksoy F, Ozturan O, Acar H, ErtaƟ B, Bayraktar F, et al. Open functional neck dissection: surgical efficacy and electrophysiologic status of the neck and accessory nerve. J Otolaryngol Head Neck Surg. 2010;39:403-9 pubmed
  30. Al Shekhlee A, Katirji B. Spinal accessory neuropathy, droopy shoulder, and thoracic outlet syndrome. Muscle Nerve. 2003;28:383-5 pubmed
    ..These two cases demonstrate that unilateral droopy shoulder secondary to trapezius muscle weakness may cause compression of the thoracic outlet structures. ..
  31. Beric A, Kelly P, Rezai A, Sterio D, Mogilner A, Zonenshayn M, et al. Complications of deep brain stimulation surgery. Stereotact Funct Neurosurg. 2001;77:73-8 pubmed
    ..Although there were no fatalities or permanent severe disabilities encountered, it is important to extend the informed consent to include all potential complications. ..
  32. Alafaci C, Salpietro F, Montemagno G, Grasso G, Tomasello F. Spasmodic torticollis due to neurovascular compression of the spinal accessory nerve by the anteroinferior cerebellar artery: case report. Neurosurgery. 2000;47:768-71; discussion 771-2 pubmed
    ..This is the first reported case of spasmodic torticollis attributable to compression by the AICA; usually, the blood vessels involved are the vertebral artery and the posteroinferior cerebellar artery. ..
  33. Leffert R. Nerve lesions about the shoulder. Orthop Clin North Am. 2000;31:331-45 pubmed
    ..This article presents the most commonly encountered lesions as well as an algorithm for their diagnosis and treatment...
  34. Durmaz B, Kirazli Y, Atamaz F. Isolated spinal accessory nerve palsy after coronary artery bypass: an unusual complication. Am J Phys Med Rehabil. 2007;86:865-7 pubmed
    ..This case report suggests that isolated spinal accessory nerve palsy should be considered in cases of shoulder pain or weakness after CABG, and conservative treatment is recommended if palsy develops. ..
  35. Teboul F, Bizot P, Kakkar R, Sedel L. Surgical management of trapezius palsy. J Bone Joint Surg Am. 2005;87 Suppl 1:285-91 pubmed
    ..Treatment is less likely to succeed when the patient is older than fifty years of age or the palsy was due to a radical neck dissection, penetrating injury, or spontaneous palsy. ..
  36. Kurokawa R, Tabuse M, Yoshida K, Kawase T. Spinal accessory schwannoma mimicking a tumor of the fourth ventricle: case report. Neurosurgery. 2004;54:510-4; discussion 514 pubmed
    ..Intracisternal-type spinal accessory schwannomas sometimes mimic a tumor of the fourth ventricle. Total surgical resection can be achieved with good outcome. ..
  37. Levy O, Relwani J, Mullett H, Haddo O, Even T. The active elevation lag sign and the triangle sign: new clinical signs of trapezius palsy. J Shoulder Elbow Surg. 2009;18:573-6 pubmed publisher
    ..These are simple clinical signs, easy to perform which are useful in diagnosing trapezius weakness in clinical practice. Level 2-1; Evidence obtained from well-designed controlled trials without randomization. ..
  38. Bradley P, Ferlito A, Silver C, Takes R, Woolgar J, Strojan P, et al. Neck treatment and shoulder morbidity: still a challenge. Head Neck. 2011;33:1060-7 pubmed publisher
    ..Finally, rehabilitation will be considered. ..
  39. Ozalp T, Yercan H, Okcu G, Erkan S. [The modifed Eden-Lange procedure for paralysis of the trapezius muscle]. Acta Orthop Traumatol Turc. 2007;41:159-62 pubmed
    ..After a two-year follow-up, asymmetry in the shoulder decreased, there was no pain on active abduction, and the patient returned to active sports and was fully satisfied with the outcome. ..
  40. Roren A, Fayad F, Poiraudeau S, Fermanian J, Revel M, Dumitrache A, et al. Specific scapular kinematic patterns to differentiate two forms of dynamic scapular winging. Clin Biomech (Bristol, Avon). 2013;28:941-7 pubmed publisher
    ..These kinematic findings show two different scapular patterns that are specific to the neurological lesion. Moreover our kinematic data relate to specific clinical signs and the functional roles of the muscles involved. ..
  41. Sandrini A, Turetta G, Fattovich G. [Diagnostic complexities and anatomical surprises in a case of thyroid surgery for papillary carcinoma]. Chir Ital. 2007;59:877-81 pubmed
    ..A fairly unusual anatomical complication was also detected with regard to the right inferior laryngeal nerve, i.e. an anastomotic branch connecting the main trunk to the vagus nerve. ..
  42. Mizobuchi K, Kincaid J. Accessory neuropathy after high-dose radiation therapy for tongue-base carcinoma. Muscle Nerve. 2003;28:650-1 pubmed
  43. Laska T, Hannig K. Physical therapy for spinal accessory nerve injury complicated by adhesive capsulitis. Phys Ther. 2001;81:936-44 pubmed
    ..This case report illustrates the importance of accurate diagnosis and suggests physical therapy intervention to manage adhesive capsulitis as a consequence of spinal accessory nerve injury. ..
  44. Opie N, Ur Rehman K, James G. A case of Collet-Sicard syndrome presenting to the Oral and Maxillofacial Surgery Department and a review of the literature. Br J Oral Maxillofac Surg. 2010;48:e9-11 pubmed publisher
  45. Lee S, Seo H, Oh B, Choi H, Cheon G, Lee S. Increased (18)F-FDG uptake in the trapezius muscle in patients with spinal accessory neuropathy. J Neurol Sci. 2016;362:127-30 pubmed publisher
    ..This is the first clinical report of increased FDG uptake by denervated muscles in electrophysiologically confirmed neuropathy. ..
  46. Wills A, Sawle G. Accessory nerve palsies. Pract Neurol. 2010;10:191-4 pubmed publisher
    ..Here the causes of accessory nerve palsies are reviewed and the symptoms and signs arising as a consequence are summarised. In addition, the various treatments and their indications are highlighted and discussed. ..
  47. McGarvey A, Chiarelli P, Osmotherly P, Hoffman G. Physiotherapy for accessory nerve shoulder dysfunction following neck dissection surgery: a literature review. Head Neck. 2011;33:274-80 pubmed publisher
    ..Such a study has the potential to improve the functional outcome and quality of life in this patient group, and ultimately to promote best practice guidelines for management. ..
  48. Van Den Bossche P, Van Den Bossche K, Vanpoucke H. Laryngeal zoster with multiple cranial nerve palsies. Eur Arch Otorhinolaryngol. 2008;265:365-7 pubmed
    ..PCR of erosional exsudate confirmed the clinical diagnosis. Antiviral therapy and corticosteroids possibly contributed to the prosperous evolution with complete healing. ..
  49. Connolly B, Turner C, Devine J, Gerlinger T. Jefferson fracture resulting in Collet-Sicard syndrome. Spine (Phila Pa 1976). 2000;25:395-8 pubmed
    ..The importance of a thorough neurologic examination, including examination of the cranial nerves, in all cases of cervical spine injury cannot be overemphasized. ..
  50. Seror P. Accessory nerve lesion after cervicofacial lift: clinical and electrodiagnostic evaluations of two cases. Muscle Nerve. 2009;39:400-5 pubmed publisher
    ..Clinical and especially electrodiagnostic findings suggested that the accessory nerve lesion was related to conduction block in the first case and severe axonal loss in the second case. ..
  51. Sinha A, Jesudason E, Mallucci C, Losty P, Kokai G, Pizer B. Infantile myofibromatosis of the craniovertebral junction. Br J Neurosurg. 2008;22:575-7 pubmed publisher
    ..Craniovertebral (CV) junction lesions are rare. We report the successful management of a solitary IM involving the posterior elements of the CV junction in a 6-month-old child. ..
  52. Yamashita M, Yamamoto T, Nakayama K. [Unilateral fatty degeneration of tongue seen in a case of Villaret syndrome]. Brain Nerve. 2007;59:634-5 pubmed
  53. Liechty P, Tubbs R, Loukas M, Blount J, Wellons J, Acakpo Satchivi L, et al. Spinal accessory nerve meningioma in a paediatric patient: case report. Folia Neuropathol. 2007;45:23-5 pubmed
    ..To the authors' knowledge, this is the first reported spinal accessory nerve meningioma in a pediatric patient. ..