Trapezius Paralysis

Overview

For patients in Richmond, VA seeking specialized care, understanding the mechanics of trapezius paralysis is the first step toward recovery. The trapezius is the large, diamond-shaped muscle on your back responsible for lifting (shrugging) and retracting the shoulder blade. It is powered by the spinal accessory nerve. Injury to this nerve cause paralysis of the trapezius and the scapula suffers from what has historically ben called “lateral winging." Unlike “medial winging” from serratus anterior paralysis, the shoulder blade doesn't just stick out—it droops. The entire shoulder girdle sags, causing massive strain on the neck and making it nearly impossible to lift the arm to the side.

Symptoms

  • Asymmetry: The affected shoulder sits visibly lower than the healthy side.

  • Loss of Abduction: Inability to lift the arm sideways above 90 degrees.

  • Neck Pain: Severe tension headaches and neck pain due to the weight of the arm dragging on the levator scapulae muscle.

Causes

  • Iatrogenic: Unfortunately, the most common cause is accidental injury during a lymph node biopsy or neck surgery.

  • Blunt Trauma: Direct blow to the base of the neck.

Non-Operative Management

  • Physical Therapy: Focused on maintaining range of motion to prevent the shoulder from freezing while waiting for nerve recovery.

  • Medication: Anti-inflammatory medication such as NSAIDs can be used to alleviate pain.

When is Surgery Needed?

  • Chronic Palsy: If the nerve does not recover, the loss of function is often too severe to tolerate. Tendon transfers are the gold standard.

Surgical Solutions

  • Triple Tendon Transfer: This novel technique involes transferring three scapular muscles that are still working. They are shifted a few inches from their current locations to new locations so that they better recreate the form and function of the trapezius muscle.

  • Scapulothoracic Fusion: A salvage option when a triple tendon transfer fails or a patient is not a good candidate for it.