Ateþli silah yaralanmasýna baðlý spinal aksesuar sinir palsi: Olgu sunumu

Spinal aksesuar sinir yaralanmalarý seyrek görülür ve çoðunlukla iyatrojeniktir. Aðrý, ayný taraf omuzun kaldýrýlmasýnda güçlük ve kol abdüksiyonunda skapular kanatlanma, en sýklýkla görülen klinik bulgulardýr. Ender rastlanan bir olgu olmasý nedeniyle, 20 yaþýnda, ateþli silaha baðlý penetran yaralanma sonrasýnda spinal aksesuar sinir palsili bir erkek olgu sunuldu. Yaralanmadan üç ay sonra, sol kolunu omuz hizasýna kadar abdüksiyona getirdiðinde aðrý ve harekette kýsýtlýlýktan þikayetçiydi. Fiziksel incelemesinde sol trapez kasý erimiþ ve omuzu düþmüþ þekildeydi. Nörolojik incelemede sol trapez ve sternokleidomastoid kaslarýnýn motor fonksiyonlarý 3/5 idi; boyun, omuz ve kolda yaygýn dizestezi vardý. Mermi, klavikulanýn üzerinden girip, trapez kasýndan çýkmýþtý. Radyolojik incelemeler normaldi fakat elektromiyelografi’de (EMG) nöropatik deðiþiklikler saptandý. Cerrahi eksplorasyonda sinirin trasesi boyunca doðal seyirini izlediði görüldü ve dekompresyon amaçlý eksternal nörolizis yapýldý. Ameliyat sonrasý sorunsuz geçti. Dizestezi ilerleyen günlerde kayboldu. Fizik tedavi de uygulanan hastanýn üç ay sonraki kontrol muayenesinde motor fonksiyonlar 4/5 idi ve EMG’de sol spinal aksesuar sinirde iyileþme saptandý.

Spinal accessory nerve palsy following gunshot injury: a case report

Injuries to the spinal accessory nerve are rare and mostly iatrogenic. Pain, impaired ability to raise the ipsilateral shoulder, and scapular winging on abduction of the arm are the most frequently noted clinical manifestations. As a seldom case, a 20 year-old male with spinal accessory nerve palsy after penetrating trauma by gunshot was reported. Three months after the injury, he was complaining about left arm pain in abduction to shoulder level and a decreased range of movement. On physical examination, wasting of the left trapezium with loss of nuchal ridge and drooping of the shoulder were found. On neurological examination of the left trapezius and sternomastoid muscles, motor function were 3/5 and wide dysesthesia on the neck, shoulder and arm was present. The bullet entered just above the clavicle and exited from trapezium. Radiological studies were normal, where electromyography (EMG) showed neuropathic changes. Surgical exploration showed the intact nerve lying on its natural course and we performed external neurolysis for decompression. The postoperative period was uneventful. Dysesthesia has diminished slowly. He was transferred to physical rehabilitation unit. In his clinical control after 3 months he had no dysesthesia and neurological examination of the left trapezius and sternomastoid muscles motor function were 4/5. EMG showed recovery in the left spinal accessory nerve.