13.17 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 shrug their shoulders.
   • Normally, the client should be able to lift up/shrug shoulders.
   • Abnormal findings are limited to no ROM and inability to shrug shoulders.
3. Place hand on client’s cheek and have them turn their neck against resistance.
   • 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. Shoulders and neck full resistance bilaterally.”
   • Abnormal findings might be documented as: “Right shoulder lower than left. Client unable to shrug right shoulder fully with decreased resistance.”