The purpose of the surgery is to stabilize the scapula and create a substitute for the trapezius, which creates significant improvement in pain and function. It can dramatically reduce pain for patients with an injury to the spinal accessory nerve.
Your shoulder blade (scapula) is the platform from which every arm movement starts. When the spinal accessory nerve is injured, the trapezius muscle-which is responsible for bringing the scapula up and in-can no longer hold the scapula in its normal position on the ribcage. The result is lateral scapular winging-the shoulder blade moving down and out. This creates constant strain and pain of the other muscles and nerves involved in shoulder movement.
The Eden‑Lange procedure transfers three small muscles from the top inner corner of the shoulder blade further outwards to compensate for the function of the trapezius.
The potential causes of injury to the spinal accessory nerve include:
- Surgical procedure in the “posterior triangle” of the neck, such as lymph node biopsy or excision of lesions
- Trauma
- Radiation treatment for cancer of the neck
“Your shoulder blade is the platform from which every arm movement starts.”
Why treatment is required
Untreated lateral scapular winging leada to constant neck and shoulder pain and limited use of the affected arm.
Common symptoms include:
- Feeling or seeing the shoulder blade droop with the inability to hold it up
- Burning or aching pain around the shoulder blade, neck, or upper arm
- Weakness and pain in the muscles of the neck, making it hard to turn the head
There are no non-surgical options that can effectively address the pain and loss of function associated with the paralyzed trapezius from the injury to the spinal accessory nerve.
How treatment is performed
While the patient is under general anesthesia, a 6 cm incision is made along the outer border of the scapula. The levator scapulae and rhomboid minor and major tendons are detached from their usual insertion point, along with a small piece of bone. They are then moved laterally (sideways), and re‑attached to the scapular spine, the supraspinatus, and infraspinous fossa with strong, non-absorbable sutures. This new placement reproduces the upward- and medial‑pulling action of the trapezius, holding the scapula in its normal position.
The surgery takes about 90 minutes. Most patients are already struggling with pain management prior to surgery and therefore stay overnight at the hospital for pain management with oral medications.
Risks and benefits
Following the Eden-Lange procedure, patients typically experience:
- Significant relief of pain
- Correction of the scapula position to its normal position
- Improvement in the use of their arm for activities of daily living
- Alleviation of neck and shoulder pain and strain
While uncommon, potential risks of the procedure can include infection, excessive bleeding, or a postoperative hematoma. Another risk can be failure of the transferred tendons to heal securely to the bone. These risks can be minimized by careful adherence to the post-operative protocol (including no lifting of the arm), no smoking, and good nutrition. Dr. Romeo also aims to minimize these issues by using meticulous cautery to control bleeding, and securing the tendons with modern sutures.
“Untreated scapular winging can lead to chronic neck and shoulder pain, limited overhead activity, and early rotator‑cuff problems.”
Physical therapy protocols
You will gradually ease into a routine of simple exercises that can be done at home. After six weeks, it will be time to begin a program of physical therapy to build strength in the joint and extend your range of motion.
It is important not to place excessive stress on the shoulder as it recovers. Around 8 weeks, physical therapy can become more ambitious.
Pain control
Some discomfort is expected after Eden-Lange surgery, especially during the first one to two weeks. Dr. Romeo will provide specific instructions for post-operative pain management before you go home. Ice, anti-inflammatory medicine (if allowed), and sleeping slightly reclined can help reduce discomfort.
Recovery time
Most patients can return to activities of daily living by three months and light recreational activites below shoulder level by six months. Some patients may develop enough strength to perform overhead activities at nine months to one year but this is uncommon.
Results
Most patients will eliminate the need for opioid medications within four to six weeks following surgery, and may not require any additional medications (e.g., NSAIDs, Tylenol) after three months. Patients will continue to work towards normal sleep and activity patterns, including light recreational activities throughout much of their first year. Occasionally, patients will be able to progress to overhead sports.
FAQs
What is the purpose of the Eden-Lange procedure?
An injury to the spinal accessory nerve can be very painful and disabling. When the nerve is injured, the large trapezius muscle that helps hold the scapula in the right position no longer works. Because the trapezius doesn’t work, it’s not possible to hold the scapula in its normal position. Instead, it drifts down and out, causing continuous strain on the remaining muscles and nerves of the shoulder blade. The Eden‑Lange procedure takes the remaining healthy muscles and transfers them to substitute for the trapezius’ function. The purpose of the surgery is to stabilize the scapula and create a substitute for the trapezius, which creates significant improvement in pain and function. It can dramatically reduce pain for patients with an injury to the spinal accessory nerve.
Is it an option to repair the nerve instead?
Yes. It may be possible to use a nerve graft within three months of the original injury. After that time frame, muscle transfer yields more predictable results.
Will I have visible scars?
Possibly. The scar is typically not visible while wearing a t-shirt or blouse.
For more information about scapulothoracic fusion surgery, please request an appointment with experienced Chicago orthopaedic surgeon, Dr. Anthony Romeo. Call (708) 766-3663 to schedule your visit.
