Axillary nerve injury in young adults--an overlooked diagnosis? Early results of nerve reconstruction and nerve transfers.
An injury to the axillary nerve from a shoulder trauma can easily be overlooked. Spontaneous functional recovery may occur, but occasionally reconstructive surgery is required. The time frame for nerve reconstruction procedures is from a neurobiological view crucial for a good functional outcome. This study presents a group of operatively and non-operatively treated young adults with axillary nerve injuries caused by motorcycle accidents, where the diagnosis was set late. Ten young men (median age at trauma 13 years, range 9-24) with an axillary nerve injury were diagnosed by examination of shoulder function and electromyography (EMG). The patients had either a nerve reconstruction procedure or were treated conservatively and their recovery was monitored. The axillary nerve was explored and reconstructed at a median of 8 months (range 1-22 months) after trauma in 8/10 patients. Two patients were treated non-operatively. In 4/8 cases, a reconstruction with sural nerve graft was performed and in 1/8 case only exploration of the nerve was made (minor neuroma). In 3/8 cases a radial nerve branch transfer to the axillary nerve was chosen as the procedure. The shoulder was mobilised after 3 weeks with physiotherapy and the patients were monitored regularly. Functional recovery was observed in 9/10 cases (median follow up 11 months, range 7-64) with EMG signs of reinnervation in seven patients. Axillary nerve function should not be overlooked in young patients with a minor shoulder trauma. Nerve reconstruction can successfully recreate function.
Department of Clinical Sciences in Malmö/Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden. lars.dahlin@med.lu.se
Lars B
LB
Dahlin
Marcus
M
Cöster
Anders
A
Björkman
Clas
C
Backman
D000293:Adolescent; D002648:Child; D004576:Electromyography; D006801:Humans; D008297:Male; D016067:Nerve Transfer; D019635:Neurosurgical Procedures; D059348:Peripheral Nerve Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012782:Shoulder / Q000294:innervation*; D000070599:Shoulder Injuries; D055815:Young Adult