During a fight in a tavern, a 45-year-old male construction worker received a shallow stab wound from a broken beer bottle at a point near the middle of the left posterior triangle of his neck. Upon physical examination it is observed that the left shoulder is drooping lower than the right shoulder, and the superior angle of the scapula juts out slightly. Strength in turning the head to the right or left appears to be symmetric. Which of the following nerves is most likely injured?
The left spinal accessory nerve has been injured distal to the sternocleidomastoid muscle, resulting in paralysis of the trapezius, allowing the shoulder to droop and the superior angle to push out posteriorly. The sternocleidomastoid muscles are intact, as demonstrated by symmetry in strength in turning the head to the right and left. There is no indication of paralysis of the lateral rotators of the shoulder or elbow flexors (suprascapular nerve or upper trunk). Thoracodorsal nerve injury would result in paralysis of the latissimus dorsi, an extensor, and medial rotator of the humerus.
Suprascapular nerve in the supraspinous fossa
The terminal segment of the dorsal scapular nerve
The upper trunk of the brachial plexus
The spinal accessory nerve in the posterior cervical triangle
Upper Extremity