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Picture

Axillary nerve injury following anterior shoulder dislocation

5/7/2014

1 Comment

 
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One of the greatest risks following an anterior shoulder dislocation is damage to the neurovascular structures which surround the glenohumeral joint.  Due to their anatomical location, certain nerves are at a higher risk of injury than others following a dislocation. Additionally the position and displacement of the arm during the injury is another factor to consider. For example, "a fall with the arm in full abduction and internal rotation causes major tension on all nerves and cords." The Visser et al article also mentioned that concurrent fractures and the presence of a hematoma increasead the risk of nerve damage. Nerves that are at the greatest risk of injury include the axillary, suprascapular, and musculocataneous nerves. Throughout the literature, authors have found that the axillary nerve is most frequently and severely damaged (Visser). 

The axillary nerve originates from the upper trunk, posterior cord of the brachial plexus carrying nerve fibers from C5-C6. It courses around the surgical neck of the humerus before entering the quadrilateral space (see middle picture below to review the space boundaries). The nerve gives off muscular branches to the deltoid, teres minor, and long head of the triceps brachii. Due to the close association to the surgical neck, the axillary nerve is often compromised during an anterior-inferior shoulder dislocation. A study by Visser et al found that 42% of their 77 patients had axillary nerve insult following a low-velocity trauma anterior shoulder dislocation. 

Picture
Picture
Picture
Due to the high incidence of nerve related injuries, a complete neurovascular examination is warranted following a shoulder dislocation. This examination should include MMT of the shoulder and arm musculature, palpating for the brachial pulse, and examining sensation of the arm. When assessing for axillary nerve damage in particular, a clinician should look for muscle atrophy of the teres minor and deltoid muscles. One should suspect weak flexion, abduction, and external rotation of the shoulder. Observation and palpation would reveal a flat shoulder deformity due to deltoid atrophy. Additionally, they will have a lose of sensation over the upper lateral arm around the deltoid region due to denervation of the superior lateral cutaneous nerve of the arm (see right picture above). 

-Jim  
References:
Visser, C. P. J., L. N. J. E. M. Coene, R. Brand, and D. L. J. Tavy. "The Incidence of Nerve Injury in Anterior Dislocation of the Shoulder and Its Influence on Functional Recovery." The Journal of Bone and Joint Surgery 81.4 (1999): 679-85. Web.
1 Comment
Personal Trainer Huntington Beach CA link
5/12/2014 08:51:40 pm

Chiropractic clinics, health care centers and pilates fitness institutes are nothing less than a boon for victims of lower back pains. Chiropractors, health care experts and pilates instructors avert back problems from getting deteriorated. Standing or sitting for a protracted period of time can lead to chronic pain.

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  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test