Traumatic injury of the axillary nerve identified after rotator cuff repair
Abstract
Introduction: The prevalence of shoulder pain varies between 6.7% and 66.7%; whereas rotator cuff disorders–especially rupture–can reach a prevalence of 22.1%. Due to the important advances and studies in the repair of this injury, arthroscopic surgery has allowed a better identification, visualization and classification, as well as a better handling of the patients. In addition, rotator cuff ruptures or greater tuberosity fractures increase the risk of nerve injury (relative risk -1.9), which is more significant in patients >60 years old. We discuss the case of a patient with post-traumatic rotator cuff rupture who required minimally invasive arthroscopic repair. No weight-bearing was allowed during the postoperative period. Patient presented a non-self-limited axillary nerve injury secondary to anterior dislocation and resulting instability after the original trauma.Conclusions: Axillary nerve injuries are more common than expected and, in many cases, early identification is not possible due to its high rate of association with other injuries. Therefore, treating physicians must be very careful in order to achieve a timely diagnosis and management of the patient.Downloads
References
Bibliografía
Whittle S, Buchbinder R. In the clinic: Rotator cuff disease. Ann Intern Med 2015;162(1):ITC1-15. https://doi.org/10.7326/AITC201501060
Millett PJ, Warth RJ. Posterosuperior rotator cuff tears: classification, pattern recognition, and treatment. J Am Acad Orthop Surg 2014;22(8):521-34. https://doi.org/10.5435/JAAOS-22-08-521
Khiami F, Gérometta A, Loriaut P. Management of recent first-time anterior shoulder dislocations. Orthop Traumatol Surg Res 2015;101(1 Suppl):S51-S7. https://doi.org/10.1016/j.otsr.2014.06.02
de Laat EA, Visser CP, Coene LN, Pahlplatz PV, Tavy DL. Nerve lesions in primary shoulder dislocations and humeral neck fractures. A prospective clinical and EMG study. J Bone Joint Surg Br 1994;76(3):381-3. PMID: 8175837
Alnot JY, Liverneaux P, Silberman O. [Lesions to the axillary nerve]. Rev Chir Orthop Reparatrice Appar Mot 1996;82:579-89. [en francés] PMID: 9091975
Paxton ES, Dodson CC, Lazarus MD. Shoulder instability in older patients. Orthop Clin North Am 2014;45(3):377-85. https://doi.org/10.1016/j.ocl.2014.04.002
Bumbasirević M, Lesić A, Vidaković A, Sudić V. [Nerve lesions after acute anterior dislocation of the humero-scapular joint–electrodiagnostic study]. Med Pregl 1993;46(5-6):191-3 [en croata]. PMID: 7869974
Robinson CM, Shur N, Sharpe T, Ray A, Murray IR. Injuries associated with traumatic anterior glenohumeral dislocations. J Bone Joint Surg Am 2012;94(1):18-26. https://doi.org/10.2106/JBJS.J.01795
Gumina S, Postacchini F. Anterior dislocation of the shoulder in elderly patients. J Bone Joint Surg Br 1997;79(4):540-3. PMID: 9250734
Levine WN, Blaine TA, Ahmad CS. Minimally invasive shoulder and elbow surgery. New York, NY: Informa Healhtcare; 2007:6.
Maman E, Morag G, Safir O, Benifla M, Mozes G, Boynton E. The anterior trunk of the axillary nerve: surgical anatomy and guidelines. A fresh, cadavers study. J Orthopaedics 2008;5(2):e7. http://www.jortho.org/2008/5/2/e7
Price MR, Tillett ED, Acland RD, Nettleton GS. Determining the relationship of the axillary nerve to the shoulder joint capsule from an arthroscopic perspective. J Bone Joint Surg Am 2004;86(10):2135-42. PMID: 15466721
Copyright (c) 2019 Revista de la Asociación Argentina de Ortopedia y Traumatología

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.


