Direct Injury to the Axillary Nerve in Athletes Playing Contact Sports

Abstract

We performed long-term followup (31 to 276 months) of 11 contact athletes who had sustained isolated injuries to their axillary nerves during athletic competition. There were no known shoulder dislocations. Electromyographs were taken of 10 patients, and all patients had confirmation of clinically defined injuries that were confined to their axillary nerves. Nine injuries were sustained while tackling opposing players in football; two were sustained in hockey collisions. In seven athletes, the mechanism of injury was a direct blow to the anterior lateral deltoid muscle. In four athletes, there were simultaneous contralateral neck flexion and ipsilateral shoulder depression. At followup, all patients had residual deficits of axillary sensory and motor nerve function. There had been no deltoid muscle improvement in three patients, moderate improvement in two patients, and major improvement in six patients. However, shoulder function remained excellent, with all athletes maintaining full range of motion and good-to-excellent motor strength. Axillary nerve exploration and neurolysis in four patients did not significantly affect the outcomes. Although no patient had full recovery of axillary nerve function, 10 of 11 athletes returned to their preinjury levels of sports activities, including professional athletics.

Quadrilateral Space Syndrome

“…23 Differential Diagnosis. A differential diagnosis for nQSS is presented in the Supplemental Table and includes suprascapular nerve entrapment and complex regional pain syndrome, 61 overt shoulder trauma, 62,63 and iatrogenesis. 64-69 C5 and/or C6 radiculopathy should also be ruled out, as found in the case of patient 9.…”

Neurotisation du nerf du chef long du muscle triceps sur le nerf axillaire, dans les paralysies isolées du deltoïde

“…Il existe également des « Hourglass-like constrictions ». La récupération spontanée est la règle dans 65 à 85 % des cas [9][10][11][12][13][14].…”

“…Le score Quick DASH était de 13,75 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). L'indice de satisfaction était de 3,25 (1-4) sur une échelle cotée de 1 à 4.…”

Axillary nerve injury associated with sports

“…Perlmutter and colleagues described compression of the axillary nerve by a helmeted head blow as it travels on the deep surface of the deltoid. [24][25][26] Direct blunt trauma to the anterolateral aspect of the shoulder via the same mechanism has also been noted to cause axillary nerve injury. There may also be a traction component associated with this injury, as scarring of the axillary nerve distal to the quadrilateral space, as well as scarring to the intramuscular portion of the nerve, has been identified.…”

“…4 Axillary nerve injury resulting from a direct blow to the anterolateral shoulder, however, has a less optimistic prognosis. Perlmutter et al [24][25][26] noted persistent paralysis of the deltoid with such injuries in 11 athletes at 2.5-23 years after injury.…”