Trapezius Palsy

with Rehab

The trapezius is a large muscle of the upper back that helps to control the shoulder blade (scapula) and stabilize the spine. Trapezius palsy is a condition affecting the nervous system in the trapezius muscle. The condition results in pain and weakness in the back of the shoulder and upper back. Shoulder function is also decreased, because the scapula contains the socket for "ball and-socket" joint of the shoulder. Trapezius palsy is caused by injury to the spinal accessory nerve, which connects to the trapezius muscle.

SYMPTOMS

  • Pain that is achy and in the shoulder and/or upper back.

  • Decreased shoulder function and/ or strength.

  • Scapula protrudes (winging of the scapula).

  • Back pain when sitting in a chair with a hard back due to the scapula winging and placing pressure on the back of the chair.

  • Shrinkage (atrophy) of the trapezius muscle, this may or may not make the neckline look asymmetric.

  • Shoulder drooping.

CAUSES

Trapezius palsy is caused by damage to the spinal accessory nerve, which is connected to the trapesius muscle. This condition is often associated with acromioclavicular (AC) or sternoclavicular subluxation (adjacent bones becoming out of proper alignment, but the joint surfaces are still touching). Common mechanisms of injury include:

  • Direct trauma to the shoulder (like being hit with an object or falling on the shoulder).

  • Complication of previous surgery that causes nerve damage.

RISK INCREASES WITH:

  • Contact sports (ie. football, rugby, or lacrosse).

  • Surgery around the neck.

  • Poor strength and flexibility.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

PROGNOSIS

Trapezius palsy usually resolves spontaneously within 3 to 6 months. Non-surgical (conservative) treatments may help decrease the severity of symptoms.

RELATED COMPLICATIONS

  • Permanent nerve damage, including pain, numbness, tingle, or weakness.

  • Inability to compete at a high level.

  • Recurrent symptoms that result in a chronic problem.

  • Shoulder stiffness.

TREATMENT

Treatment initially involves resting from any activities that aggravate the symptoms, and the use of ice and medications to help reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home or with referral to a therapist. A therapist may recommend further treatment, such as:

  • The use of electric current to simulate the nerves (transcutaneous electronic nerve stimulation (TENS)).

  • Ultrasound.

If symptoms are severe, your caregiver may recommend you wear a brace to decrease discomfort. If symptoms persist for more than 6 months despite non-surgical treatment, surgery may be recommended (uncommon).

MEDICATION

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or soak your injury in warm water.

SEEK MEDICAL CARE IF:

  • Treatment seems to offer no benefit, or the condition worsens.

  • Any medications produce adverse side effects.

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Trapezius Palsy (Spinal Accessory Nerve Palsy)

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

STRETCH – Flexion, Standing

  • Stand with good posture. With an underhand grip on your right / left and an overhand grip on the opposite hand, grasp a broomstick or cane so that your hands are a little more than shoulder-width apart.

  • Keeping your right / left elbow straight and shoulder muscles relaxed, push the stick with your opposite hand to raise your right / left arm in front of your body and then overhead. Raise your arm until you feel a stretch in your right / left shoulder, but before you have increased shoulder pain.

  • Try to avoid shrugging your right / left shoulder as your arm rises by keeping your shoulder blade tucked down and toward your mid-back spine. Hold __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH – Abduction, Supine

  • Stand with good posture. With an underhand grip on your right / left and an overhand grip on the opposite hand, grasp a broomstick or cane so that your hands are a little more than shoulder-width apart.

  • Keeping your right / left elbow straight and shoulder muscles relaxed, push the stick with your opposite hand to raise your right / left arm out to the side of your body and then overhead. Raise your arm until you feel a stretch in your right / left shoulder, but before you have increased shoulder pain.

  • Try to avoid shrugging your right / left shoulder as your arm rises by keeping your shoulder blade tucked down and toward your mid-back spine. Hold __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ROM – Flexion, Active-Assisted

  • Lie on your back. You may bend your knees for comfort.

  • Grasp a broomstick or cane so your hands are about shoulder-width apart. Your right / left hand should grip the end of the stick/cane so that your hand is positioned "thumbs-up," as if you were about to shake hands.

  • Using your healthy arm to lead, raise your right / left arm overhead until you feel a gentle stretch in your shoulder. Hold __________ seconds.

  • Use the stick/cane to assist in returning your right / left arm to its starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH - External Rotation and Abduction

  • Stagger your stance through a doorframe. It does not matter which foot is forward.

  • Choose one of the following positions as instructed by your physician, physical therapist or athletic trainer: place your hands:

  • and forearms above your head and on the door frame.

  • and forearms at head-height and on the door frame.

  • at elbow-height and on the door frame.

  • Keeping your head and chest upright and your stomach muscles tight to prevent over-extending your low-back, slowly shift your weight onto your front foot until you feel a stretch across your chest and/or in the front of your shoulders.

  • Hold __________ seconds. Shift your weight to your back foot to release the stretch.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Trapezius Palsy (Spinal Accessory Nerve Palsy)

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress with the resistance and repetition exercises only as your caregiver advises.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

STRENGTH - Scapular Depression and Adduction

  • With good posture, sit on a firm chair. Support your arms in front of you with pillows, arm rests or a table top. Have your elbows in line with the sides of your body.

  • Gently draw your shoulder blades down and toward your mid-back spine. Gradually increase the tension without tensing the muscles along the top of your shoulders and the back of your neck.

  • Hold for __________ seconds. Slowly release the tension and relax your muscles completely before completing the next repetition.

  • After you have practiced this exercise, remove the arm support and complete it while standing as well as sitting.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Shoulder Abductors, Isometric

  • With good posture, stand or sit about 4-6 inches from a wall with your right / left side facing the wall.

  • Bend your right / left elbow. Gently press your right / left elbow into the wall. Increase the pressure gradually until you are pressing as hard as you can without shrugging your shoulder or increasing any shoulder discomfort.

  • Hold __________ seconds.

  • Release the tension slowly. Relax your shoulder muscles completely before you do the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Shoulder Flexion, Isometric

  • With good posture and facing a wall, stand or sit about 4-6 inches away.

  • Keeping your right / left elbow straight, gently press the top of your fist into the wall. Increase the pressure gradually until you are pressing as hard as you can without shrugging your shoulder or increasing any shoulder discomfort.

  • Hold __________ seconds.

  • Release the tension slowly. Relax your shoulder muscles completely before you do the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Internal Rotators

  • Secure a rubber exercise band/tubing to a fixed object so that it is at the same height as your right / left elbow when you are standing or sitting on a firm surface.

  • Stand or sit so that the secured exercise band/tubing is at your right / left side.

  • Bend your elbow 90 degrees. Place a folded towel or small pillow under your right / left arm so that your elbow is a few inches away from your side.

  • Keeping the tension on the exercise band/tubing, pull it across your body toward your abdomen. Be sure to keep your body steady so that the movement is only coming from your shoulder rotating.

  • Hold __________ seconds. Release the tension in a controlled manner as you return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - External Rotators

  • Secure a rubber exercise band/tubing to a fixed object so that it is at the same height as your right / left elbow when you are standing or sitting on a firm surface.

  • Stand or sit so that the secured exercise band/tubing is at your side that is not injured.

  • Bend your elbow 90 degrees. Place a folded towel or small pillow under your right / left arm so that your elbow is a few inches away from your side.

  • Keeping the tension on the exercise band/tubing, pull it away from your body, as if pivoting on your elbow. Be sure to keep your body steady so that the movement is only coming from your shoulder rotating.

  • Hold __________ seconds. Release the tension in a controlled manner as you return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Shoulder Extensors

  • Secure a rubber exercise band/tubing so that it is at the height of your shoulders when you are either standing or sitting on a firm arm-less chair.

  • With a thumbs-up grip, grasp an end of the band/tubing in each hand. Straighten your elbows and lift your hands straight in front of you at shoulder height. Step back away from the secured end of band/tubing until it becomes tense.

  • Squeezing your shoulder blades together, pull your hands down to the sides of your thighs. Do not allow your hands to go behind you.

  • Hold for __________ seconds. Slowly ease the tension on the band/tubing as you reverse the directions and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Shoulder Extensors, Prone

  • Lie on your stomach on a firm surface so that your right / left arm overhangs the edge. Rest your forehead on your opposite forearm. With your thumb facing away from your body and your elbow straight, hold a __________ weight in your hand.

  • Squeeze your right / left shoulder blade to your mid-back spine and then slowly raise your arm behind you to the height of the bed.

  • Hold for __________ seconds. Slowly reverse the directions and return to the starting position, controlling the weight as you lower your arm.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Horizontal Abductors

Choose one of the two oppositions to complete this exercise.

Prone (lying on stomach):

  • Lie on your stomach on a firm surface so that your right / left arm overhangs the edge. Rest your forehead on your opposite forearm. With your palm facing the floor and your elbow straight, hold a __________ weight in your hand.

  • Squeeze your right / left shoulder blade to your mid-back spine and then slowly raise your arm to the height of the bed.

  • Hold for __________ seconds. Slowly reverse the directions and return to the starting position, controlling the weight as you lower your arm.

Repeat __________ times. Complete this exercise __________ times per day.

Standing:

  • Secure a rubber exercise band/tubing so that it is at the height of your shoulders when you are either standing or sitting on a firm arm-less chair.

  • Grasp an end of the band/tubing in each hand and have your palms face each other. Straighten your elbows and lift your hands straight in front of you at shoulder height. Step back away from the secured end of band/tubing until it becomes tense.

  • Squeeze your shoulder blades together. Keeping your elbows locked and your hands at shoulder-height, bring your hands out to your side.

  • Hold __________ seconds. Slowly ease the tension on the band/tubing as you reverse the directions and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Scapular Retractors and Elevators

  • Secure a rubber exercise band/tubing so that it is at the height of your shoulders when you are either standing or sitting on a firm arm-less chair.

  • With a thumbs-up grip, grasp an end of the band/tubing in each hand. Step back away from the secured end of band/tubing until it becomes tense.

  • Squeezing your shoulder blades together, straighten your elbows and lift your hands straight over your head.

  • Hold for __________ seconds. Slowly ease the tension on the band/tubing as you reverse the directions and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.