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Arch Phys Med Rehabil. 2009 Nov;90(11):1969-72. doi: 10.1016/j.apmr.2009.06.015.

Spinal accessory neuropathy associated with deep tissue massage: a case report.

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Department of Physical Medicine and Rehabilitation, Mayo Clinic Arizona, 13400 E. Shea Blvd, Scottsdale, AZ 85259, USA.


Spinal accessory neuropathy (SAN) causes impaired arm mobility and pain. The spinal accessory nerve is often injured during surgical procedures such as neck dissection for tumor resection or cervical lymph node biopsy. Other traumatic injuries may also occur. SAN causes weakness of the trapezius muscle and, less frequently, of the sternocleidomastoid muscle. The clinical consequence of trapezius muscle weakness includes impaired stability of the scapula leading to upper limb dysfunction and pain. We present a rare and illustrative case of SAN associated with deep tissue massage leading to scapular winging and droopy shoulder as a result of weakness of the trapezius muscle.

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