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[Lesions to the axillary nerve]

J Y Alnot1, P Liverneaux, O Silberman

  • 1Département de Chirurgie du Membre Supérieur, Hôpital Bichat, Paris.

Revue De Chirurgie Orthopedique Et Reparatrice De L'Appareil Moteur
|January 1, 1996
PubMed
Summary

Surgical repair of axillary nerve lesions, particularly nerve grafts, shows promising outcomes for patients with persistent deltoid muscle palsy. Early diagnosis and intervention are key for successful recovery from these complex nerve injuries.

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Area of Science:

  • Orthopedic Surgery
  • Neurosurgery
  • Traumatology

Background:

  • Axillary nerve lesions are often associated with shoulder trauma, including dislocations and fractures.
  • Delayed diagnosis of deltoid muscle palsy can occur despite normal shoulder abduction, impacting treatment timing.
  • Comprehensive review of 67 axillary nerve lesions over a six-year period.

Purpose of the Study:

  • To analyze the outcomes of surgical interventions for isolated and associated axillary nerve lesions.
  • To evaluate the effectiveness of different surgical techniques, including nerve grafting and neurolysis.
  • To determine optimal timing and methods for repairing axillary nerve injuries.

Main Methods:

  • Retrospective review of 67 axillary nerve lesions (1987-1993).
  • Analysis of lesion types: isolated, associated with other nerve injuries (suprascapular, musculocutaneous, posterior cord), or rotator cuff injuries.
  • Surgical approaches included nerve grafting, neurolysis, and direct suture, often combined with osteoarticular procedures.

Main Results:

  • For isolated axillary nerve lesions (35 cases), 57% achieved good to excellent results after surgical repair (average 9 months post-injury).
  • Associated lesions showed variable outcomes: 50% good/excellent for axillary + suprascapular/musculocutaneous nerve lesions; aleatory results for posterior cord lesions.
  • Rotator cuff injuries associated with axillary nerve lesions had outcomes dependent on lesion type and repair success.

Conclusions:

  • Surgical repair, particularly nerve grafting, is recommended for axillary nerve lesions with persistent deltoid palsy (3-6 months).
  • Early diagnosis and timely surgical intervention are crucial for improving functional recovery.
  • Combined surgical approaches may be necessary for complex injuries involving multiple nerve structures and rotator cuff tears.

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