Axillary nerve dysfunction

Definition

Axillary nerve dysfunction is a loss of movement or sensation of the shoulder because of nerve damage.

Alternative Names

Causes

Axillary nerve dysfunction is a form of peripheral neuropathy. It occurs when there is damage to the axillary nerve, which supplies the deltoid muscles of the shoulder. A problem with just one nerve group, such as the axillary nerve, is called mononeuropathy.

Direct injury to the shoulder and pressure on the nerve can lead to axillary nerve dysfunction.

Conditions associated with axillary nerve dysfunction include:

• Fracture of the upper arm bone
• Pressure from casts or splints
• Improper use of crutches
• Shoulder dislocation
• Body-wide disorders that cause nerve inflammation

In some cases, no cause can be identified.

Symptoms

• Numbness over part of the outer shoulder
• Shoulder weakness
• Difficulty lifting objects with the sore arm
• Difficulty lifting arm above the head

Exams and Tests

Your health care provider will examine the arm and shoulder. There may be weakness of the shoulder with difficulty moving the arm.

The deltoid muscle of the shoulder may show signs of muscle atrophy.

Tests that reveal axillary nerve dysfunction may include:

• EMG
• Nerve biopsy
• MRI

Treatment

Some people do not need treatment, and they get better on their own.

Anti-inflammatories may be given if you have sudden symptoms, little sensation or movement changes, no history of injury to the area, and no signs of nerve damage. These medicines reduce swelling and pressure on the nerve. They may be injected directly into the area or taken by mouth.

You may need over-the-counter or prescription pain medicines to control pain. If you have stabbing pains, your doctor may prescribe other medications, such as phenytoin, carbamazepine, gabapentin

If your symptoms continue or get worse, you may need surgery. Surgery may be done to see if a trapped nerve is causing your symptoms. In this case, surgery to release the nerve may help you feel better.

Physical therapy may help you maintain muscle strength. Job changes, muscle retraining, or other forms of therapy may be recommended.

Outlook (Prognosis)

It may be possible to make a full recovery if the cause of the axillary nerve dysfunction can be identified and successfully treated.

Possible Complications

• Partial or complete shoulder paralysis
• Partial or complete loss of sensation in the arm (uncommon)
• Recurrent injury to the arm
• Deformity of the arm, shoulder contracture or fibrosis (frozen shoulder)

When to Contact a Medical Professional

Call for an appointment with your health care provider if you have symptoms of axillary nerve dysfunction. Early diagnosis and treatment increase the chance of controlling symptoms.

Prevention

Preventative measures vary, depending on the cause. Avoid prolonged pressure on the underarm area. Examine casts, splints, and other appliances for proper fit. Crutch training should include instructions not to place pressure on the underarm.

Marx J. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. St. Louis, Mo: Mosby; 2006:672.

Noble J. Textbook of Primary Care Medicine. 3rd ed. St. Louis, Mo: Mosby; 2001:1143.