SPINAL ACCESSORY

NERVE
CN XI
ABOUT
• Is a motor nerve .
• Formed by union of cranial and spinal nerve root.
• Spinal root originates at lateral side of cervical spine before it
enters foramen magnum.

• FUNCTIONS :
❑To supply motor part of trapezius and to SCM, & so to influence
the posture and movements of head and shoulder girdle

Special Visceral efferent (SVE)

COURSE IN BRIEF

Originates in two parts

Cranial = Nuclear Ambigous (In medulla – b/w pyramid and olive)
Spinal (Spinal Nucleus – Ant grey column , first 5 CXvertebra)

Both route unite in

Juglar foramen and
leaves skull as
accessory nerve
COURSE IN BRIEF

Nerve then separates into cranial and spinal parts

Spinal part supplies

Cranial Part- joins vagus
nerve , distribute in
phalangeal branch and
supply soft palate
Sterneocleido-mastoid ,
pierces SCM , passes
through posterior triangle
of neck and supplies to
trapezius muscle
FUNCTION OF THE TEST
› To detect weakness and wasting , unilateral or bilateral ,
of these muscles.
ON OBSERVATION
› Trapezius muscle weakness may be suspected if head fall
forwards.
› SCM weakness if head fall backwards
SCM
› Place 1 hand on right side of face and ask him to turn his
head at that side. left SCM stand out.
› Repeat in opp side and compare bulk and strength.
› Then place hand on his forehead and ask him to bend his
head forward. Both SCM will stand out.
› Ask patient to sit up .Normally head leaves the pillow first
and movement is easy.
TRAPEZIUS
› Go behind patient and compare line and curve of trapezii
and position of scapulae, to ensure that he is sitting
symmetrical.
› Ask him to raise shoulders to ears. Examiner tries to
depress the shoulders forcibly

› https://neurologicexam.med.utah.edu/adult/html/crania
lnerve_normal.html
ABNORMALITIES
• SCM wasted or absent :
› Neck appears elongated,thin
› Thyroid cartilage and gland stand out abnormally.
• Bilateral SCM Weakness :
› When patient sits up head seems to left behind on pillow
and is then raised with difficulty.
› Platysma may stand out to an extent of drawing the
mouth downwards
ABNORMALITIES CONT..
UNILATERAL SCM WEAKNESS :
› Patient fail to turn his head against resistance on opp
side.

TRAPEZIUS WEAKNESS :
› Shoulder drooping on 1 side and scapula displaced
downward and laterally.
› Shrugging of that shoulder may be weak.
THANK YOU