200 Section - A Case Study of Rare Bilateral Spinal Accessory Neuropathy in Neuralgic Amyotrophy: The Importance of a Rehabilitation Approach to Scapular Winging.

Tuesday, May 19, 2026

6:00 PM - 7:30 PM PT

Presenting Author/Autor expositor(s)

SK

Sydney Knight, MD

Resident
Western University
London, Ontario, Canada

Co-Author/Coautor(s)

Thomas A. Miller, MD (he/him/his)

Physical Medicine and Rehabilitation Physician
University of Western Ontario
London, Ontario, Canada

Case Diagnosis:
Case Diagnosis: Bilateral spinal accessory neuropathy in neuralgic amyotrophy (NA).

Case Description:

Case Description: A 22-year-old man experienced right shoulder pain in June 2022 followed by scapular winging. Examination revealed right trapezius atrophy. Electrodiagnostic studies demonstrated reduced right spinal accessory compound muscle action potential amplitude with absent volitional units, later evolving to reinnervation in the middle and lower trapezius. Genetic testing for facioscapulohumeral muscular dystrophy was negative. MRI excluded styloid process elongation. By July 2023, the right shoulder function had partially improved, but he developed similar left-sided trapezius weakness after a similar history of acute pain in May 2023. Spine MRI excluded skull base tumours but revealed an incidental hydromyelia (C6–T1). MRI neurography was unable to localize hourglass constrictions or focal abnormalities in either spinal accessory nerve.

Discussions:

Discussion: A paradigm shift has occurred in the assessment of NA. The clinical assessment includes wall push-ups, scapular assistance maneuvers, and prone retraction. The long thoracic, suprascapular, or anterior interosseous nerves are more commonly affected, while spinal accessory nerve involvement, especially bilaterally, remains rare. Rehabilitation is central in the care of NA. Targeted programs emphasize trapezius and rhomboid strengthening (prone I-T-Y exercises, scapular re-setting, and resisted/isometric retraction) supplemented with biofeedback or neuromuscular electrical stimulation. Although most cases are managed conservatively, nerve decompression or transfer, tendon transfers (Eden-Lange Procedure) or scapulothoracic fusion may be considered if deficits persist.

Conclusions:

Conclusion: Rehabilitation with targeted scapular retraining and proprioceptive re-education enabled meaningful shoulder function recovery in this rare case of bilateral spinal accessory neuropathy secondary to NA.

NA with bilateral spinal accessory involvement is rare presentation of NA and requires careful evaluation to exclude other structural or neuromuscular causes.

Focused rehabilitation that emphasises scapular retraining and restoration of the middle and inferior trapezius (scapula stabilizers) and rhomboids to improve scapulothoracic kinesiology is central to functional recovery.