Perlmutter G S, Apruzzese W
Orthopaedic Surgery Service, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Sports Med. 1998 Nov;26(5):351-61. doi: 10.2165/00007256-199826050-00005.
Axillary nerve injuries are some of the most common peripheral nerve injuries in athletes who participate in contact sports. Resulting deltoid muscle paralysis is secondary to nerve trauma which occurs following shoulder dislocation or a direct blow to the deltoid muscle. Compression neuropathy has been reported to occur in quadrilateral space syndrome as the axillary nerve exits this anatomic compartment. The axillary nerve is also extremely vulnerable during any operative procedure involving the inferior aspect of the shoulder, and iatrogenic injury to the axillary nerve remains a serious complication of shoulder surgery. Accurate diagnosis of axillary nerve injury is based on a careful history and physical examination as well as an understanding of the anatomy of the shoulder and the axillary nerve in particular. Inspection, palpation and neurological testing provide the bases for diagnosis. A clinically suspected axillary nerve injury should be confirmed by electrophysiological testing, including electromyography and nerve conduction studies. During the acute phase of injury, the athlete should be rested and any ligamentous or bony injury should be treated as indicated. Patients should undergo an extensive rehabilitation programme emphasising active and passive range of motion as well as strengthening of the rotator cuff, deltoid and periscapular musculature. Shoulder joint contracture should be avoided at all costs as a loss of shoulder mobility may ultimately affect functional outcome despite a return of axillary nerve function. If no axillary nerve recovery is observed by 3 to 4 months following injury, surgical exploration is indicated. Athletes who sustain injury to the axillary nerve have a variable prognosis for nerve recovery, although the return of function of the involved shoulder is typically good to excellent. We recommend that athletes who sustain axillary nerve injury may return to contact sport participation when they achieve full active range of motion of the shoulder and when shoulder strength is documented to be good to excellent by isometric or manual muscle testing.
腋神经损伤是从事接触性运动的运动员中最常见的周围神经损伤之一。肩脱位或三角肌直接受击后发生的神经创伤会导致三角肌麻痹。据报道，腋神经穿出四边形间隙时，会在四边形间隙综合征中发生压迫性神经病变。在任何涉及肩部下方的手术过程中，腋神经也极易受损，腋神经的医源性损伤仍然是肩部手术的严重并发症。腋神经损伤的准确诊断基于详细的病史、体格检查，尤其要了解肩部及腋神经的解剖结构。视诊、触诊和神经学检查为诊断提供依据。临床怀疑的腋神经损伤应通过电生理检查来确诊，包括肌电图和神经传导研究。在损伤急性期，应让运动员休息，并按指征治疗任何韧带或骨损伤。患者应接受广泛的康复计划，重点是主动和被动活动范围以及加强肩袖、三角肌和肩胛周围肌肉组织。应不惜一切代价避免肩关节挛缩，因为尽管腋神经功能恢复，但肩部活动度丧失最终可能影响功能结果。如果损伤后3至4个月未观察到腋神经恢复，则需进行手术探查。腋神经损伤的运动员神经恢复预后不一，不过受累肩部的功能恢复通常良好至极佳。我们建议，腋神经损伤的运动员在肩部达到完全主动活动范围且通过等长或手法肌力测试证明肩部力量良好至极佳时，可恢复参加接触性运动。
