What is Traumatic Axillary Nerve Palsy?
Peripheral nerve injuries are possible in developmental ages due to trauma. Axillary nerve trauma can occur following a proximal humerus fracture or a shoulder dislocation. These are caused by overly stretching the shoulder joint or by receiving acute physical trauma by an external force. Arm overhead sports with traction are the most common cause—pitching, gymnastics, javelin, volleyball, football, climbing, pull-ups, rugby. Brachial plexus injuries may involve this nerve.
Since only one nerve is compromised with this injury, it is referred to as mononeuropathy. It is often stretched during glenohumeral dislocation.
Characteristics and Clinical Presentation of Traumatic Axillary Nerve Palsy
This injury is caused by damage or entrapment of the axillary nerve. When it is traumatized or becomes entrapped, the nerve pathway is disrupted, which reduces or blocks input and output through the nerve. Over time or acutely the myelin sheath becomes compromised due to this stretch or entrapment. Because this injury presents with different or overlapping symptoms with other conditions diagnosis may not be straight forward. Some patients cannot perform shoulder abduction, extension or flexion regardless of reporting pain or not.
Patients may report weakness in the deltoid muscle. Sometimes pain may not be noticed until after much use.
The most commonly reported symptoms of traumatic axillary nerve injuries include:
- Cannot perform shoulder elevation.
- Deficiency of deltoid muscle function.
- Different regions of skin around the deltoid area can lack sensation, usually lateral.
- Unable to raise arm at the shoulder.
- Numbness or tingling in the shoulder region.
- Weakness in the shoulder.
- Difficulty lifting your arm above your head.
- Difficulty lifting, pushing and pulling objects.
Getting a Diagnosis for Traumatic Axillary Nerve Palsy
Diagnosing injuries to the axillary nerve evolves from a careful musculoskeletal and neurological examination. Patients may experience weakness and atrophy of the deltoid muscle, with recurring numbness of part of the shoulder.
Additionally, electrodiagnostic studies in addition to an MRI and X-ray are helpful in confirming a diagnosis and cause, which can rule out other nerve disorders and injuries.
Treatment Options for Traumatic Axillary Nerve Palsy
In many cases, an axillary nerve injury will heal on its own. Spontaneous recovery is possible due to the short distance between the axillary nerve traumatic site and the deltoid muscle, and the limited nature of the injury. Because nerve injuries are slow to heal, it may take anywhere from a few weeks to many months for the injury to fully resolve. And some do not. During this time, it is important to keep the shoulder in a comfortable position, avoiding traction or pulling on the arm.
For axillary nerve injuries that may heal on their own without surgical intervention, most without laceration, temporary immobilization of the arm in a sling may be considered. Anti-inflammatory non-steroidal pain management may be prescribed if pain and discomfort continues during the healing period.
The shoulder and deltoid muscle function will be closely monitored by an orthopedic hand surgeon with expertise in upper extremity nerve disorders like Drs. Pruzansky during this time.
If after several months the weakness or pain do not improve, nerve surgery may be discussed.
A branch of the radial nerve may be taken from the triceps muscle and transferred to the axillary nerve, in a procedure known as a nerve transfer. Nerve graft from the calf may be harvested to replace the damaged section of the axillary nerve. Here it will grow into the deltoid muscle on its own. This procedure allows the deltoid muscle to begin moving again.
Preventing Traumatic Axillary Nerve Palsy
Injury to the axillary nerve is often sustained during dislocations or fractures of the humerus and neck and brachial plexus injuries. These injuries may be caused by stretching the shoulder joint and neck or by receiving acute or chronic physical trauma or stretching during athletic activities.
Knowing your strength, endurance, and skills limits, protective gear, and use of best techniques have the potential to reduce injury to the axillary nerve.
Prognosis for Traumatic Axillary Nerve Palsy
Recovery with conservative or surgical methods are both a lengthy process. The period can last well over a year in some cases. Full recovery can be managed most not all of the time. Muscle weakness from axillary nerve injury typically benefits from supervised physical therapy. Physical therapy is recommended in all cases requiring surgical intervention in order to reduce scar tissue and to maintain range of motion of the nerve and shoulder. Muscle atrophy is also addressed.
If You Believe You Have Traumatic Axillary Nerve Palsy, Contact HandSport Surgery Institute.
Please contact us to schedule an appointment with our talented team. People who have been hurt should be evaluated to try to reduce further injury and mobility issues and to optimize your return.
If you have been injured, it’s important to be evaluated by a highly skilled professional. Call Drs. Mark and Jason Pruzansky at 212-249-8700 to schedule an appointment and obtain an accurate diagnosis.