Acquired isolated axillary neuropathy: an unusual complication of quadriplegia

This report describes a rare case of acquired axillary neuropathy in a 17-year-old C-5 quadriplegic man who developed right axillary neuropathy after sleeping for six hours in a far-right lateral decubitus position. Two days after the onset of shoulder weakness, his shoulder abduction strength was found to have decreased 1 1/2 grades from measurements made 2 weeks before. Electrodiagnostic studies demonstrated no voluntary activity of the deltoid and no deltoid evoked response on stimulation at Erb's point, while shoulder nerve conduction latencies to other C-5 and posterior cord innervated muscles were within normal limits, suggesting a diagnosis of axillary nerve compression in the region of the quadrilateral space. Six and one-half months later, after strengthening exercises and shoulder joint support to prevent subluxation, the patient recovered deltoid strength and upper extremity function beyond that seen at the onset of the axillary neuropathy. This case emphasizes the importance of proper body positioning of spinal cord injured (SCI) patients to prevent peripheral nerve compression and further disability.