Modified Eden-Lange Triple Tendon Transfer Procedure for Idiopathic Spinal Accessory Nerve Palsy and Scapular Winging

The scapula serves as the transition point at which the energy from the lower body and core transmits through the scapulothoracic articulation and the upper extremity. Spinal accessory nerve palsy leads to lateral winging of the scapula and abnormal scapulothoracic motion. Resultant abnormal motion and asynchrony of the scapulothoracic articulation can disrupt the upper extremity kinetic chain, leading to pain, atrophy, and dysfunction of the shoulder. Disruption of this kinetic chain can severely impair patients and athletes who engage in physically demanding activities. Conservative management alone with anti-inflammatories, lifestyle changes, and physical therapy has not produced encouraging results. Surgical management options include a tendon transfer (Eden-Lange, triple tendon transfer) or nerve repair. We present a case of an active duty service member with idiopathic spinal accessory nerve palsy treated with triple tendon transfer. After the triple tendon transfer, this patient experienced improvements in pain, range of motion, and function at 1-year postoperatively, also maintaining enough strength and function to pass their physical fitness assessments and remain on active duty. As such, these findings may suggest the triple tendon transfer procedure offers a viable option in the treatment of spinal accessory nerve palsy in the active patient populations who require a high level of physical function.