Surgical Algorithm and Results of Isolated Traumatic Axillary Nerve Injuries

Abstract

In patients with preserved triceps strength, a triceps branch of the radial nerve can be coapted directly to the axillary nerve in the absence of deltoid contraction following electrical stimulation. Functional improvements were seen in patients treated with neurolysis alone and in combination with nerve transfer, supporting the use of intraoperative axillary nerve stimulation to guide treatment.

Isolated Axillary Nerve Injury in an Elite High School American Football Player: A Case Report

“…27 Surgical reconstruction of a closed axillary nerve injury via nerve graft or nerve transfer is recommended when there is no spontaneous recovery 3 to 6 months after the injury. 1, 5,24 Multiple studies have demonstrated that a triceps nerve to axillary nerve transfer leads to increased deltoid strength in both pediatric and adult populations with axillary nerve injury. 8,14,27,29 This surgery may increase shoulder endurance postoperatively.…”

“…At 3 months postinjury, the lack of spontaneous recovery (the absence motor units on electromyography [EMG]) is an indication for surgery. 4,5,24 By contrast, if the surgery is delayed and evidence of acute denervation (fibrillations or positive sharp waves on EMG) is no longer present, nerve transfers are less likely to be successful. 25 Additionally, a surgical decompression of the quadrangular space with step lengthening of the long head of the triceps tendon may relieve a conduction block in the axillary nerve.…”

“…16,27,29 Nerve grafts can also improve deltoid strength after an axillary nerve injury. 5,18,28 In a systematic review of nerve transfer and nerve graft reconstructions for posttraumatic, isolated, axillary nerve injuries, there was no significant difference between nerve graft and nerve transfer procedures in the recovery of shoulder abduction. 12 However, nerve transfers may allow for faster reinnervation of muscles compared with nerve grafting because the nerve transfer can be performed closer to the neuromuscular junction (L. F. Domeshek et al, unpublished data, 2019).…”

Shoulder Subluxation Pain as a Secondary Indication for Trapezius to Deltoid Transfer

“…14 Chen et al reported transferring a triceps branch of the radial nerve to the axillary nerve in patients without deltoid function (but preserved triceps strength) and found that both the neurolysis alone and the nerve transfer groups had significant improvements in deltoid strength and shoulder abduction from a mean of 63 to 127 degrees. 15 When patients present outside the window for neurotization or fail to have shoulder function improvement after brachial plexus nerve reconstruction, tendon transfer is the initial reconstructive step. Few muscles are available after the injury for tendon transfer.…”

Лікування «нещасливої Тріади» Плечового Суглоба

“…При порівнянні віддалених результатів пластики та невротизації аксилярного нерва значних розбіжностей виявлено не було. В обох випадках спостерігались добрі результати відновлення сили дельтоподібного м'яза у 80-86 % до М4-М4+, та у 57 % досягнуто М5 [1,3,5,7].…”