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Surgical Algorithm and Results of Isolated Traumatic Axillary Nerve Injuries
Wayne A Chen1, David W Schippert1, Snow B Daws1
1Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
Journal of Reconstructive Microsurgery
|October 17, 2015
Summary
Surgical treatment for acute isolated axillary nerve injuries, including neurolysis and nerve transfer, significantly improved shoulder function and patient outcomes. Intraoperative nerve stimulation guided successful treatment decisions.
Area of Science:
- Orthopedic Surgery
- Neurosurgery
- Trauma Surgery
Background:
- Axillary nerve injuries frequently result from high-energy trauma.
- Developing a treatment algorithm for acute isolated axillary nerve injuries is crucial.
Purpose of the Study:
- To propose a treatment algorithm for acute isolated axillary nerve injuries.
- To evaluate outcomes of surgically treated patients with these injuries.
Main Methods:
- Retrospective review of 14 patients with isolated axillary nerve injuries.
- Axillary nerve neurolysis and, in select cases, triceps branch radial nerve transfer to the axillary nerve.
- Assessment of deltoid strength, shoulder abduction, and DASH scores pre- and postoperatively.
Main Results:
- 86% of patients achieved M4 or greater deltoid strength post-surgery.
- Mean shoulder abduction improved significantly from 63 to 127 degrees.
- Disabilities of the Arm, Shoulder, and Hand (DASH) scores improved significantly.
Conclusions:
- Direct coaptation of the radial nerve triceps branch to the axillary nerve is effective in cases without deltoid contraction.
- Both neurolysis alone and combined with nerve transfer yield functional improvements.
- Intraoperative axillary nerve stimulation effectively guides surgical treatment decisions.
