Axillary Nerve Injury: Difference between revisions
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**Blunt trauma.<ref name="Allen et al" /><ref name="Apaydin et al" /><ref name="Miller" /><br><br> | **Blunt trauma.<ref name="Allen et al" /><ref name="Apaydin et al" /><ref name="Miller" /><br><br> | ||
<ref name="Vitanzo et al">Vitanzo P, Kenneally B. Diagnosis of isolated axillary neuropathy in athletes:case studies. The Journal of Musculoskeletal Medicine. 2009; 26:307-311.</ref><br> | |||
== '''Characteristics/Clinical Presentation''' == | == '''Characteristics/Clinical Presentation''' == | ||
Revision as of 06:41, 29 November 2010
Welcome to Texas State University's Evidence-based Practice project space. This is a wiki created by and for the students in the Doctor of Physical Therapy program at Texas State University - San Marcos. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!
Original Editors
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Search Strategy[edit | edit source]
Search Databases: CINHAL, Cochrane Library, EBSCO, Medline with Full Text, ProQuest, PubMed, SAGE, ScienceDirect, SpringerLink
Search Terms: anterior shoulder dislocation, axillary nerve, axillary nerve rehabilitation, axillary neuropathy, axillary nerve fracture, instability conservative treatment, nerve injury with anterior dislocation, physical therapy axillary, physical therapy shoulder dislocation, shoulder dislocation, shoulder dislocation nerve, and shoulder dislocation peripheral nerve
Search Timeline: 10/11/2010-11/23/2010
Definition/Description[edit | edit source]
It is characterized by trauma to the axillary nerve from either a compressive force or traction injury following anterior dislocation of the shoulder.[1][2][3][4][5][6][7][8][9][10]
Epidemiology/Etiology[1][2][3][4][5][6][7][8][9][10][edit | edit source]
- Anterior dislocation is the most common occurring dislocation at the shoulder.[2][3][4][5][6][8][9]
- Men and women 3:1[5]
- 9-65% involve axillary nerve injury[2][8][9][11][12]
- 23% have combination neuropathies, all involving the axillary nerve[8]
- The incidence of brachial plexus and axillary nerve injury increases dramatically following shoulder dislocation in patients ≥50 years of age, if fracture is associated with the dislocation, and if the duration of the dislocation lasts >12 hours[8][9][10][13][14]
- Incidence of nerve injury doubled with the presence of an associated fracture[10]
- Incidence of nerve injury doubled with the presence of an associated fracture[10]
- Traction and compression to the axillary nerve[1][2][6][7][9][10]
- The axillary nerve becomes stretched across the humerus as it dislocates anteriorly and inferiorly.[2][9]
- Propagated tension due to overstretching of the axillary nerve over the humeral head during shoulder dislocations may cause elongation of the free portion of the axillary nerve and the increased tension may even result in axillary nerve avulsions from the posterior cord of brachial plexus.[2][9]
- The axillary nerve is susceptible to injury at several sites, including the origin of the nerve from the posterior cord, the anterior inferior aspect of the subscapularis muscle and shoulder capsule, the quadrilateral space, and within the subfascial surface of the deltoid muscle.[9]
- Blunt trauma.[1][2][6]
- The axillary nerve becomes stretched across the humerus as it dislocates anteriorly and inferiorly.[2][9]
Characteristics/Clinical Presentation[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Examination[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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Key Research[edit | edit source]
There is only minimal, low quality evidence regarding isolated axillary nerve injury in shoulder dislocations, consisting mostly of descriptive and exploratory studies.
- Nerve Injury About the Shoulder in Athletes, Part 1- A descriptive study that reviews the anatomy of the axillary nerve, presentation and clinical examination, diagnostic tests, differential diagnosis, and treatment of axillary nerve injury, with emphasis on early recognition and diagnosis of this type of injury.
- Axillary Nerve Injuries in Contact Sports: Recommendations for Treatment and Rehabilitation- A descriptive study that discusses the relevant anatomy, proper examination and diagnosis of the axillary nerve injury, differential diagnosis (to include cervical spine clearing), conservative treatment, indications for surgical intervention, complications and prognosis, and rehabilitation. In regards to treatment, there is emphasis placed on the axillary nerve injury in conjunction with the shoulder dislocation.
- Diagnosis of Isolated Axillary Neuropathy in Athletes: Case Studies- The most recent case studies in the diagnosis of axillary nerve injury.
Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 1.2 1.3 Allen J, Dean K. Recognizing, managing, and testing an axillary- nerve dysfunction. Athletic Therapy Today. 2002;7(2):28-29.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Apaydin N, Tubbs S, Loukas M, Duparc F. Review of the surgical anatomy of the axillary nerve and the anatomic basis of its iatrogenic and traumatic injury. Springer. 2010;32:193-201.
- ↑ 3.0 3.1 3.2 Cutts S, Prempeh M, Drew S. Anterior shoulder dislocation. Ann R Coll Surg Engl. 2009:91:2-7.
- ↑ 4.0 4.1 4.2 Duralde X. Neurologic injuries in the athlete’s shoulder. Journal of Athletic Training. 2000;35(3):316-328.
- ↑ 5.0 5.1 5.2 5.3 Handoll HHG, Hanchard NCA, Goodchild LM, Feary J. Conservative management following closed reduction of traumatic ; anterior dislocation of the shoulder (review). Cochrane Database of Systematic Review. 2006;1:1-26.
- ↑ 6.0 6.1 6.2 6.3 6.4 Miller T. Peripheral nerve injuries at the shoulder. The Journal of Manual&amp;amp;amp;amp;amp;amp; Manipulative Therapy. 1998;6(4)170-183.
- ↑ 7.0 7.1 7.2 Neal S, Fields K. Peripheral nerve entrapment and injury in the upper extremity. American Family Physician. 2010; 81(2): 147-155.
- ↑ 8.0 8.1 8.2 8.3 8.4 8.5 Payne M, Doherty T, Sequeira K, Miller T. Peripheral nerve injury associated with shoulder trauma: a retrospective study and review of literature. Journal of Clinical Neuromuscular Disease. 2002; 4(1): 1-6.
- ↑ 9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 Perlmutter G, Apruzzese W. Axillary nerve injuries in contact sports: recommendations for treatment and rehabilitation. Sports Med. 1998;26(5): 351-360.
- ↑ 10.0 10.1 10.2 10.3 10.4 Visser C, Coene L, Brand R, Tavy D. The incidence of nerve injury in anterior dislocation of the shoulder and its influence on functional recovery a prospective clinical and emg study. Journal of Bone and Joint Surgery. British volume. 1999; 81-B(4). 679-685.
- ↑ Cox C, Kuhn J. Operatice versus nonoperative treatment of acute shoulder dislocation in the athlete. Current Sports Medicine Reports. 2008;7(5): 263-268.
- ↑ McFarland E, Caicedo J, Kim T, Banchasuek P. Axillary nerve injury in anterior shoulder reconstructions: use of a subscapularis muscle- splitting technique and a review of the literature. Am J Sports Med. 2002;30:601-606.
- ↑ Kazemi M. Acute traumatic anterior glenohumeral dislocation complicated by axillary nerve damage: a case report. Journal of the Canadian Chiropractic Association. 1998;42(3):150-155.
- ↑ Safran M. Nerve injury about the shoulder in athletes, Part 1: Suprascapular nerve and axillary nerve. Am J Sports Med . 2004;32(3):803-819.
- ↑ Vitanzo P, Kenneally B. Diagnosis of isolated axillary neuropathy in athletes:case studies. The Journal of Musculoskeletal Medicine. 2009; 26:307-311.
