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605 - Accessory Nerve Injury after CABG in a Rehabilitation Patient: A Case Report

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

EJ

Elizabeth A. Jelloe, DO

Resident Physician
SUNY Upstate
Syracuse, New York, United States

Co-Author(s)

AN

Andreea Nitu-Marquise, MD

Attending Physician, Assistant Professor of Physical Medicine and Rehabilitation
SUNY Upstate
Syracuse, New York, United States

Case Diagnosis: Accessory Nerve Injury

Case Description: This report is of a 77 year old male admitted to a skilled nursing facility for anoxic brain injury following cardiac arrest. The patient underwent cardiac catheterization and was found to have severe multivessel disease necessitating CABG. Following the procedure, the patient had shoulder pain, limited shoulder abduction, and lateral scapular winging most likely from spinal accessory nerve damage during the CABG.

Discussions: Clinical features of spinal accessory neuropathy include weakness in shoulder abduction beyond 90 degrees and winging of the scapula. A common cause of this neuropathy is local surgery. Injury to this nerve during CABG is rare but mechanisms of nerve damage may include traction, compression during sternal retraction, and injury during mammary aftery dissection. Most neuropathies that follow cardiac surgery improve after three weeks, so conservative management with therapy is recommended. Therapy should focus on range of motion, stabilization, and compensatory muscle strengthening to prevent complications like contracture and adhesive capsulitis. Persistent symptoms may be indicative of more serious axonal injury warranting electrodiagnostic study. If there is no symptomatic improvement within six months, nerve grafting may be necessary, with the best outcomes occurring if done within this period. In this case, conservative management failed, thus the patient was referred for electrodiagnostic testing and may require surgical intervention.

Conclusions:
This case highlights that cardiac surgery can damage the spinal accessory nerve, affecting upper extremity function. While EMG can aid diagnosis, it is not always necessary as this injury can resolve within weeks. Physiatrists should recognize cardiac surgery as a cause of this injury so it can be identified early in the treatment course of cases where surgery may be indicated.