Am J Sports Med 1997 Jan;25(1):65-68
Orthopaedic Surgery Service, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
We performed long-term followup (31 to 276 months) of 11 contact athletes who had sustained isolated injuries to their axillary nerves during athletic competition. There were no known shoulder dislocations. Electromyographs were taken of 10 patients, and all patients had confirmation of clinically defined injuries that were confined to their axillary nerves. Nine injuries were sustained while tackling opposing players in football; two were sustained in hockey collisions. In seven athletes, the mechanism of injury was a direct blow to the anterior lateral deltoid muscle. In four athletes, there were simultaneous contralateral neck flexion and ipsilateral shoulder depression. At followup, all patients had residual deficits of axillary sensory and motor nerve function. There had been no deltoid muscle improvement in three patients, moderate improvement in two patients, and major improvement in six patients. However, shoulder function remained excellent, with all athletes maintaining full range of motion and go od-to-excellent motor strength. Axillary nerve exploration and neurolysis in four patients did not significantly affect the outcomes. Although no patient had full recovery of axillary nerve function, 10 of 11 athletes returned to their preinjury levels of sports activities, including professional athletics.
Plast Reconstr Surg 1991 May;87(5):911-916
Division of Plastic Surgery, Johns Hopkins School of Medicine, Baltimore, Md.
We present a series of five patients with quadrilateral space syndrome. All patients had the diagnosis made on the basis of (1) tenderness over the quadrilateral space, (2) paresthesia over the lateral shoulder and upper posterior arm, and (3) deltoid weakness associated with decreased shoulder abduction. A history of trauma was present in each patient. The operative technique described utilizes a cosmetically acceptable incision and is without the need to divide the deltoid from its origin on the scapular spine. The technique minimizes postoperative bleeding and facilities rehabilitation. Arteriography of the posterior circumflex humeral artery was not found necessary to make the diagnosis of axillary nerve entrapment in the quadrilateral space.
Clin Orthop 1989 Jun;243:100-105
Royal Columbian Hospital, New Westminster, Canada.
Axillary nerve injury is a recognized complication of the capsular slide procedure for multidirectional instability of the shoulder. Axillary nerve dissection followed by an anterior or posterior capsular shift procedure was carried out on 12 autopsy subjects to observe: (1) the normal relationships of the nerve; (2) its proximity to structures dissected in the procedure; and (3) the effects upon it of both anterior and posterior capsular shift procedures. The axillary nerve arises immediately posterior to the coracoid process and conjoint tendon. It crosses the inferolateral border of the subscapularis 3 to 5 mm medial to its musculotendinous junction, and it lies in intimate contact with the inferior capsule as it passes through the quadrilateral space. The nerve should be visualized prior to transecting the subscapularis tendon. During detachment of the inferior capsule from the humeral neck, the humerus should be gradually externally rotated, and the nerve should be gently retracted with a small flat in strument. Sutures reattaching the flap should be carefully placed to avoid injuring the nerve. The tendinous insertion of the teres minor is preserved from a posterior approach. The nerve can be visualized and protected during capsular detachment.
J Hand Surg [Am] 1983 Jan;8(1):65-69
This uncommon syndrome is caused by compression of the posterior humeral circumflex artery and axillary nerve or one of its major branches in the quadrilateral space. Forward flexion and/or abduction and external rotation of the humerus aggravate the symptoms. Discrete point tenderness is always found posteriorly in the quadrilateral space. Patients with appropriate history and physical findings should have a subclavian arteriogram done by the Seldinger technique. A positive arteriogram reveals occlusion of the posterior humeral circumflex artery with the arm in abduction and external rotation. Patients with sufficient symptoms not responding to conservative treatment and having a positive subclavian arteriogram and local tenderness over the quadrilateral space should be considered for surgical decompression. A posterior approach is recommended. Of the 18 patients operated on, eight have had dramatic and complete relief, eight have been improved, and two have shown no improvement.
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