Bertelli Jayme Augusto, Ghizoni Marcos Flávio
Center of Biological and Health Sciences, Department of Neurosurgery, University of Southern Santa Catarina (Unisul), Tubarão, SC, Brazil.
J Hand Surg Am. 2011 Dec;36(12):2017-23. doi: 10.1016/j.jhsa.2011.09.011. Epub 2011 Nov 3.
To describe and validate the use of a test of abduction in internal rotation for the assessment of axillary nerve injury.
A total of 14 male patients with a mean age of 29 years (SD ± 6 y), with axillary nerve lesions lasting an average of 6 months, participated. We measured their shoulder range of motion. In the upright position, with the trunk bending forward, we asked our patients to actively extend the shoulder (swallowtail test), and then we extended the shoulders and asked each patient to hold them in that position (deltoid extension lag test). For the abduction in internal rotation test, we asked patients to abduct the shoulder in internal rotation. If full abduction compared with the normal contralateral side was not possible, the examiner passively held the affected limb in maximal abduction and internal rotation. The patient was instructed to maintain the position when the examiner released the limb. In each test, any lag compared with the normal side accounted for deltoid palsy.
All patients exhibited abduction beyond horizontal and full external rotation. The swallowtail test and the deltoid extension lag test identified the axillary nerve lesion in 10 of 14 patients. The abduction in internal rotation test recognized the axillary nerve injury in all 14. The average difference in the range of abduction in internal rotation between the normal and affected side was 37° (abduction lag).
Compensatory abduction in axillary nerve palsy has been attributed to the action of the supraspinatus, biceps, coracobrachialis, and pectoralis major. During abduction in internal rotation, compensatory abduction is impaired, clearly indicating deltoid muscle dysfunction.
描述并验证内旋外展试验在评估腋神经损伤中的应用。
共有14例平均年龄29岁（标准差±6岁）的男性患者参与，其腋神经损伤平均持续6个月。我们测量了他们的肩部活动范围。在直立位，躯干向前弯曲时，我们让患者主动伸展肩部（燕尾试验），然后我们伸展肩部并让每位患者保持在该位置（三角肌伸展滞后试验）。对于内旋外展试验，我们让患者在内旋位外展肩部。如果与对侧正常侧相比无法实现完全外展，检查者被动地将患侧肢体保持在最大外展和内旋位。当检查者松开肢体时，指示患者保持该位置。在每项试验中，与正常侧相比的任何滞后都被视为三角肌麻痹。
所有患者均表现出超过水平位的外展和完全的外旋。燕尾试验和三角肌伸展滞后试验在14例患者中的10例中识别出腋神经损伤。内旋外展试验在所有14例中均识别出腋神经损伤。正常侧和患侧在内旋外展范围上的平均差异为37°（外展滞后）。
腋神经麻痹时的代偿性外展归因于冈上肌、肱二头肌、喙肱肌和胸大肌的作用。在内旋外展过程中，代偿性外展受损，明确表明三角肌功能障碍。
