Abstract
Introduction . The axillary nerve is a terminal branch of the posterior cord of the brachial plexus and derives from the ventral rami of the fifth and sixth cranial nerves. Its injury is infrequently diagnosed and a rare occurence. It generally appears secondary to the trauma and characterized by severe shoulder pain at night with limitation of the shoulder movements followed by shoulder atrophy in the following weeks. Case Illustration: A 22-year-old male was admitted with decreased of consciousness, headache, neck stiffness, subconjunctival hemorrhage, and decreased left arm strength along with range of movement, especially left shoulder abduction and left arm pronator after a motorcycle accident. Vital signs were unremarkable. Head CT scan showed minimal subarachnoid hemorrhage (SAH) at anterior interhemisphere falx, and tripod fracture at left zygomatic bone. Hand, humeral and antebrachii X-ray showed no fracture nor dislocation. Electromyography (EMG) test showed no nerve conduction velocity of left axillary nerve injury. Patient underwent physiotherapy and given neuroprotectors. After 7 days, there was a significant improvement in shoulder abduction and left arm pronation. Patient was then discharged and scheduled for further physiotherapy. Discussion . Isolated lesions of the axillary nerve occur most commonly after a fracture or dislocation around the shoulder. Most recover spontaneously. In this case, patient had a speed recovery a week after the injury. Electrodiagnostic study shows a physiologic block of nerve conduction in the axillary nerve. At the end of the week, patient showed significant strength. This might be due to temporary interruption of conduction without loss of axonal continuity (neuropraxia). Conclusion . Isolated axillary nerve injury is often a low-grade injury which progresses to full recovery without intervention. Electrodiagnostic study might reveal no nerve conduction. However, recovery of nerve conduction deficit is full, and requires days to weeks.
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