[Lesions of the circumflex nerve. Apropos of 19 cases]

Abstract

The authors studied a series of 19 lesions of the circumflex nerve either isolated (14 cases) or in association with a lesion of the suprascapular or musculocutaneous nerves. All were treated surgically. One was caused by a gunshot wound, the others were due to traction on the axillary region, and associated with anterior dislocation of the shoulder in five cases, a fracture of the humerus in two cases and a fracture of the clavicle in one case. Despite complete paralysis of the deltoid, active abduction was often possible. The operation took place 4 to 6 months after injury. In the 14 cases of isolated lesions of the circumflex nerve, the nerve was approached both anteriorly and posteriorly. It was always found to be divided and could be repaired by grafting in 10 cases, and secondary suture in one case. On three occasions the lesion was too distal and could not be repaired. When repair was possible, two excellent and eight good results were obtained, one case being too recent for follow up. In cases of associated lesions of the circumflex and suprascapular nerves, the repair of the latter was not possible and results were poor. In contrast, in cases of associated lesions of the circumflex and musculocutaneous nerves, repair was possible with satisfactory results at the level of the deltoid and biceps. These results indicate that an earlier diagnosis would allow a repair and a more satisfactory condition of lesions which are close to the motor end plates and of relatively good prognosis.