Axillary nerve injury in young adults—An overlooked diagnosis? Early results of nerve reconstruction and nerve transfers

Abstract

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.

Key Words::

• Axillary nerve
• nerve injury
• nerve reconstruction
• nerve transfer
• sural nerve
• shoulder trauma

Acknowledgements

The project was supported by grants from the Swedish Research Council (Medicine and Science), Stiftelsen Promobilia, Magnus Bergvalls stiftelse, HKH Kronprinsessan Lovisas förening för barnasjukvård, Thelma Zoéga's Fund, Anna Lisa och Sven-Eric Lundgren's stiftelse för medicinsk forskning, Region Skåne, and funds from Skåne University Hospital, Malmö, Sweden.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.