Davidson Loren T, Carter Gregory T, Kilmer David D, Han Jay J
Department of Physical Medicine and Rehabilitation, University of California-Davis Medical Center, 4860 Y Street, Sacramento, CA 95817, USA.
Am J Phys Med Rehabil. 2007 Jun;86(6):507-11. doi: 10.1097/PHM.0b013e31805b7bcf.
A previously healthy 26-yr-old male presented for an electrodiagnostic evaluation with complaints of significant right deltoid muscle atrophy and shoulder abduction weakness after receiving an intramuscular (IM) deltoid injection of an antiemetic 4 wk earlier. Electrodiagnostic evaluation confirmed an acute axillary neuropathy. We hypothesize that direct mechanical trauma to the anterior branch of the axillary nerve resulted in axillary mononeuropathy with axonal loss, although chemically induced nerve injury cannot be excluded. Injections in and about the shoulder complex are performed routinely for the purposes of vaccination, IM medication administration, deltoid trigger-point injections, and intra-articular and bursal steroid injections. Although such injections are considered routine office procedures, there is increased risk of neurovascular injury if they are performed incorrectly. The purpose of this brief report is to make practitioners aware of the potential for axillary neuropathy with such procedures, to review the salient anatomy, and to propose a potential guideline for clinical practice to minimize iatrogenic axillary neuropathy.
一名26岁既往健康的男性因右三角肌明显萎缩及肩部外展无力前来接受电诊断评估，4周前他在三角肌进行了一次肌内注射抗呕吐药。电诊断评估证实为急性腋神经病变。我们推测，尽管不能排除化学性神经损伤，但腋神经前支受到直接机械性创伤导致了伴有轴突损失的腋单神经病。肩部复合体及其周围的注射操作常用于疫苗接种、肌内药物给药、三角肌触发点注射以及关节内和滑囊内类固醇注射。尽管此类注射被视为常规门诊操作，但如果操作不当，神经血管损伤风险会增加。本简要报告的目的是让从业者意识到此类操作导致腋神经病变的可能性，回顾相关重要解剖结构，并提出潜在的临床实践指南，以尽量减少医源性腋神经病变。
