​Spinal Accessory Nerve Dysfunction/Spinal Accessory Palsy


The spinal accessory nerve is a part of the nerve network in the skull. It is located on the side of the neck and helps control muscles responsible for specific shoulder movements (trapezius muscles), such as shrugging and or moving the shoulder blade or your arms inwards. Another group of muscles controlled by the spinal accessory nerve also help you tilt and rotate your head. Any trauma or injury to the spinal accessory nerve can cause a spinal accessory nerve injury, which affects the movement of the muscles controlled by this nerve.

Spinal accessory nerve dysfunction can occur due to damage to the nerve due to neck trauma, injury to arm or neck, or even after surgical procedures such as lymph node biopsy, parotid surgery, carotid surgery and jugular vein cannulation.

Symptoms of spinal accessory nerve dysfunction are experienced in areas affected by the muscles they control. Thus, as muscles responsible for specific shoulder and head movements are affected, the following signs and symptoms are associated with this disease:
  • Shoulder pain

  • Weakness in the shoulders

  • Inability to move shoulders in a specific way

  • Weakness with lifting

  • Droop shoulder

  • Partial paralysis of the trapezius muscles

  • Asymmetric neckline

  • Winged shoulder blade

If you experience any pain or weakness in the shoulder, which doesn’t improve after a few days or worsens over time, seek help from your doctor at The Aga Khan University Hospital.

You can be assured of receiving the best quality medical care at The Aga Khan University Hospital. Our expert and highly trained staff at the Mind and Brain Service Line can provide you with additional information and medical advice. We have an internationally accredited staff with which you can safely and privately discuss your symptoms, gain advice and receive personalized treatment and care.

Your time with your doctor may be limited, so make sure to prepare for your visit beforehand. Here are some tips to help get you started.

The diagnosis for spinal accessory nerve dysfunction begins with a detailed medical history and physical examination. In the physical examination, your doctor will ask you to move your shoulders and arms in certain ways to identify any signs of weakness in your shoulders.

Besides this, imaging tests such as the MRI (magnetic resonance imaging), CT (computed tomography) scans and X-rays may also be requested to examine the affected nerve and area closely. Electrical testing of your nerve function through tests such as the electromyography (EMG) may also be requested.

For treatment of spinal accessory nerve dysfunction, a multi-pronged approach using conservative (non-surgical) methods and surgery will be advised, depending on the severity of your disorder.

Conservative treatment options are used in case of mild, tolerable pain and gradually improving symptoms. These include the use of pain-killer medications, hot and cold compress, and anti-inflammatory medicines to help you manage your pain better. Physical therapy is the main non-surgical treatment method employed for treating spinal accessory nerve injury, about which your neurologist will guide you further.

In case conservative treatment methods do not show much improvement and symptoms have been worsening over time, surgery will be recommended for treating this disorder, especially if the disorder has been preventing your from freely moving your shoulders or arms. 

Surgery will aim to repair the nerve damage, such as by using a technique called nerve grafting to allow the nerve to regenerate. In some other cases, muscular repair may be needed through surgery as well.

With the expert attention of experienced neurologists and nerve specialists at the Mind and Brain Service Line of The Aga Khan University Hospital your treatment will be approached with sensitivity and support. It will be our constant goal to maximize your nerve function, helping improve your strength and quality of life.

Please click here for some guidelines on “what to do before your surgery”.

The decision for a surgery must be made after a thorough evaluation of the symptoms and an accurate diagnosis of your spinal accessory nerve dysfunction. Any nerve surgery procedure is susceptible to certain risks and complications, such as anaesthesia problems or fluid build-up in the lungs, or even shoulder blade fracture. However, these risks are rare.

In order to ensure that your surgical procedure is effective to an optimal level, you must follow the post-operative instructions given by your doctor, such as wearing a sling and avoiding use of the operated area for the first six weeks. You must also follow your physical therapists’ post-operative instructions regarding activity and exercise during healing process. It may take six months or up to a year for full functioning of the shoulder.

Please click here for some guidelines on “what to do after your surgery

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the ‘Important Numbers’ section on the website homepage. 

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments’ costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the ‘Important Numbers’ section on the website homepage.

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the ‘Important Numbers’ section on the website homepage.




The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.