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Direct Injury to the Axillary Nerve in Athletes Playing Contact Sports

Orthopaedic Surgery Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

Robert D. Leffert, MD

Orthopaedic Surgery Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

Bertram Zarins, MD

Orthopaedic Surgery Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

We performed long-term followup (31 to 276 months) of 11 contact athletes who had sustained isolated in juries to their axillary nerves during athletic competi tion. There were no known shoulder dislocations. Elec tromyographs were taken of 10 patients, and all patients had confirmation of clinically defined injuries that were confined to their axillary nerves. Nine injuries were sustained while tackling opposing players in foot ball ; two were sustained in hockey collisions. In seven athletes, the mechanism of injury was a direct blow to the anterior lateral deltoid muscle. In four athletes, there were simultaneous contralateral neck flexion and ipsilateral shoulder depression. At followup, all patients had residual deficits of axillary sensory and motor nerve function. There had been no deltoid muscle im provement in three patients, moderate improvement in two patients, and major improvement in six patients. However, shoulder function remained excellent, with all athletes maintaining full range of motion and good- to-excellent motor strength. Axillary nerve exploration and neurolysis in four patients did not significantly affect the outcomes. Although no patient had full re covery of axillary nerve function, 10 of 11 athletes returned to their preinjury levels of sports activities, including professional athletics.

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