The diagnosis and treatment of suprascapular nerve combined with axillary nerve injuries following the shoulder trauma

Abstract

Objective To expore the effect of nerve repair for patients with traumatic suprascapular nerve combined with axillary nerve injuries. Methods Data of 13 cases with traumatic suprascapular nerve combined axillary nerve injuries treated by surgery from June 2003 to September 2011 were retrospectively analyzed. All the cases were males, and the average age was 28 years old. There were 2 cases of neck of scapula fracture combined with clavicle fracture, 3 of floating shoulder injury, 1 of humerus neck fracture combined with glenoid cavity fracture, 3 of clavicle fracture, 1 of acromion fracture, 2 of shoulder blade fracture and 1 of atlanto-axial vertebral fractures. All the 13 cases performed isolated lost of the function of shoulder abduction and external rotation completely, and the muscle strength of deltoid, the supraspinatus and infraspinatus was M0. The electrophysiological examination showed complete denervation of axillary nerve and suprascapular nerve. The suprascapular nerve was broken in 10 cases in which 6 cases were repaired by 1 band sural nerve graft and 1 case was repaired by 1 band superficial cervical plexus, and 3 cases were irreparable because of the distal avulsion injury from the target muscle, and 3 cases were performed with neurolysis. The axillary nerve ruptured in 12 cases, in which 10 cases was repaired by 2-3 bands sural nerve graft, and fascicles selected from the median nerve were used to neurotize axillary nerve in 2 cases. The neurolysis of axillary nerve was performed at the quadrilateral space in 1 case. 10 of the 13 cases had both the suprascapular nerve and axillary nerve ruptured. Results 13 cases were followed up, the follow up period was 36 to 134 months. In 7 cases, the functional recovery of shoulder abduction were 180° and the average external rotation was 56° and the muscle strength of deltoid attained M4. In 5 cases, the average shoulder abduction was 38°; the range of external rotation was -40°-30°, and the muscle strength of deltoid achieved M4 in 1 case, M3 in 2, M2 in 2. There was no improvement in 1 case. Conclusion The suprascapular nerve associated axillary nerve injury should be suspected in the patients with isolated lost the function of shoulder abduction and external rotation completely. Repair of axillary nerve and suprascapular nerve by nerve graft simultaneously could achieve good outcome, and early surgery should be conducted. Key words: Shoulder joint; Brachial plexus; Wounds and injuries