Axillary Nerve Palsy Following Latissimus Dorsi Tendon Transfer for Irreparable Rotator Cuff Tears

Recurrent rotator cuff tears in young patients represent a complex therapeutic challenge. Latissimus dorsi tendon transfers (LDTT) are considered an effective treatment option for massive tears with deficiencies of the posterosuperior rotator cuff. However, the procedure can still produce complications, among which neurological complications are rare, particularly those involving the axillary nerve. This review presents the case of a 53-year-old male patient with an extensive, irreparable posterosuperior rotator cuff retear who underwent arthroscopically assisted LDTT without intraoperative complications. The initial postoperative course was as expected, with minimal pain and gradual improvement in passive range of motion. However, at seven weeks, delayed progression of mobility was noted, associated with hypoesthesia in the axillary nerve distribution and deltoid hypotrophy. This prompted an electrodiagnostic study. Electromyography (EMG) revealed severe axillary nerve neuropraxia with signs of acute axonal degeneration. Management was conservative, with intensive rehabilitation and close clinical follow-up. By 14 months of follow-up, the patient achieved full recovery of mobility, strength, and sensibility, with both clinical and EMG resolution of the neuropraxia.