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Spinal Accessory Nerve Injury as a Complication of Internal Jugular Vein Cannulation
- Stephen Burns, MD; and
- Gerald J. Herbison, MD
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TO THE EDITOR:
A 38-year-old woman was referred to us for electromyographic evaluation of right scapular winging. She had first noticed shoulder pain after having right internal jugular vein cannulation 15 months earlier. Signs included atrophy and decreased strength of the right trapezius and lateral winging of the scapula. Neurologic examination indicated no other findings. A small scar was present on the right lateral neck at the junction of the upper and middle thirds of the posterior border of the sternocleidomastoid. Electromyography showed chronic denervation of the entire right trapezius. The serratus anterior was normal.
Neurologic complications of central venous cannulation are relatively rare. A review article [1] identified 19 cases seen in a 20-year period that involved nerve injury in the neck region due to internal jugular vein cannulation. These cases involved damage to the phrenic nerve, recurrent laryngeal nerve, cervical roots, brachial plexus, cervical sympathetic chain, and cranial nerves. Previous reports have implicated either direct needle trauma or compression from hematoma and fluid extravasation.
One previous case of spinal accessory nerve injury has been described in the literature. As in our case, it resulted from the use of a posterior approach [2]. The recommended site for catheter insertion is the junction of the middle and lower thirds of posterior border of the sternocleiodomastoid [3]; in our patient, the catheter was inserted superior to this site. This corresponds to the position of the spinal accessory nerve as it enters the posterior triangle of the neck [4].
Several types of nerve injury can occur as complications of central venous catheterization. The spinal accessory nerve can be injured with internal jugular vein cannulation. The use of a site located superior to the recommended posterior approach site may be a contributing factor.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
