Axillary nerve palsy consequent to a guided manual stretch of the upper extremities: a case report

Reflexive breathing therapy and complementary manual therapy aim to improve breathing by mobilizing the chest, reducing the muscle tone of the breath supporting muscles, and improving secretion and chest wall compliance. We describe an uncommon case of axillary nerve (AN) palsy in association with a treatment session of reflexive breathing therapy combined with manual therapy. After a therapist's guided intensive movement of crossed arms in front of the body, upward, as high as possible, a sudden ache in the left shoulder that radiated to the lateral upper arm occurred along with loss of elevation and abduction of the shoulder. An electrophysiological examination demonstrated a diminished and delayed compound muscle action potential that indicated AN injury. Following conservative treatment, the nerve dysfunction resolved completely. Stretching of the nerve may have resulted in tearing some nerve fibers and is discussed as a possible pathophysiological mechanism.