CN XI – Spinal Accessory Nerves

This section presents a brief description of assessment of the spinal accessory nerves; more information can be found in the musculoskeletal resource. The following tests are usually performed with the client in a sitting or standing position.

1. Inspect the neck and shoulders anteriorly and posteriorly and inspect the head position.
   • Normally the neck and muscles (sternocleidomastoid and trapezius) are symmetrical and shoulders are at the same level. The head is midline and upright.
   • Abnormal findings are asymmetry of neck and muscles with a drooping shoulder or if the head droops forward, backward, or off to one side.
2. Ask the client to perform range of motion (ROM) of the neck (flexion, extension, rotation, lateral flexion) and shoulders (flexion, extension, abduction, adduction) and to shrug their shoulders.
   • Normally, ROM should not be affected and the client should be able to lift up/shrug shoulders.
   • Abnormal findings are limited to no ROM and inability to shrug shoulders.
3. Conduct manual muscle testing (MMT) of the neck (flexion, extension, rotation, lateral flexion) and shoulders (flexion, extension, abduction, adduction, shoulder shrug). All of these elements can be tested, but especially rotation to ensure the sternocleidomastoid muscle is being innervated, and shoulder shrug to ensure the trapezius muscles are being innervated.
   • Normally, the client should have full resistance bilaterally.
   • Abnormal findings are partial or no resistance on one or both sides.
4. Note the findings:
   • Normal findings might be documented as: “Spinal accessory nerve testing: Symmetrical neck and muscles with shoulders at same level. Head midline and upright. Full ROM of neck and shoulders and full resistance bilaterally.”
   • Abnormal findings might be documented as: “Right shoulder lower than left. Client unable to abduct right shoulder fully with decreased resistance.”