[Surgical repair of the axillary nerve. Apropos of 37 cases]

Abstract

The authors have reviewed the results of the operative repair of 37 injuries of the axillary nerve. In 25 patients only the axillary nerve was injured, in 8 the suprascapular nerve was also damaged and in a further 4 the musculocutaneous nerve had also sustained injury. There was an associated anterior dislocation of the shoulder in 10 patients and a fracture was present in 8. Eleven patients out of 25 had a nearly normal range of abduction in spite of paralysis of the deltoid muscle, and this accounted for delay in diagnosis. Operation was undertaken 8 months after injury using a combined anterior and posterior approach. In 34 patients disruption of the nerve had occurred in relation to the quadrilateral space. In 32 cases nerve grafts were employed, in 2 direct suture and 1 underwent neurolysis. The results were good or very good in 23 out of the 25 direct repairs of isolated axillary lesions, and in all 4 patients with associated injury to the musculocutaneous nerve. Only 4 good results were obtained in the 8 patients who also had injuries to the suprascapular nerve. The results suggest that repair should be carried out early at between 3 and 6 months. E.M.G. studies are necessary before operation for proper assessment of nerve recovery.