Spinal Accessory Nerve Injury Induced by Manipulation Therapy: A Case Report

Area of Science:

• Neurology
• Orthopedics
• Physical Medicine and Rehabilitation

Background:

• Spinal accessory nerve (SAN) injuries are predominantly associated with surgical interventions.
• Injuries to the SAN resulting from manipulation therapy are exceptionally uncommon.

Purpose of the Study:

• To report a rare case of spinal accessory nerve injury following manipulation therapy.
• To describe the clinical presentation, diagnostic findings, and treatment outcomes of this rare condition.

Main Methods:

• A case report of a 42-year-old woman presenting with shoulder pain and scapular winging post-manipulation therapy.
• Diagnostic workup included needle electromyography and nerve conduction studies to confirm SAN injury.
• Treatment involved a 2-week course of physical therapy (PT) with modalities.

Main Results:

• Electromyography and nerve conduction studies confirmed spinal accessory nerve injury.
• The patient experienced gradual pain relief and improved active range of motion (ROM) with PT.
• Over a 2-month follow-up, shoulder ROM and strength nearly returned to baseline, with complete resolution of pain.

Conclusions:

• Manipulation therapy is an infrequent but potential cause of spinal accessory nerve injury.
• Early diagnosis and comprehensive physical therapy are crucial for successful recovery from SAN injury-related shoulder dysfunction.