Isolated Axillary Nerve Injury in an Elite High School American Football Player: A Case Report

Abstract

An elite high school American football athlete sustained a traumatic, isolated, axillary nerve injury. Axillary nerve injuries are uncommon, but serious injuries in American football. With the advent of nerve transfers and grafts, these injuries, if diagnosed in a timely manner, are treatable. This case report discusses the multidisciplinary approach necessary for the diagnosis and treatment of an elite high school American football player who presented with marked deltoid atrophy. The athlete’s injury was diagnosed via electrodiagnostic testing and he underwent a medial triceps nerve to axillary nerve transfer. After appropriate postsurgical therapy, the athlete was able to return to American football the subsequent season and continue performing at an elite level. This case report reviews the evaluation and modern treatment for axillary nerve injuries in the athlete, including nerve transfers, nerve grafts, and return to play.

Determination of safe sites of intramuscular arm injections and its relevance to the community

“…[ 15 16 17 ] These findings have also been further substantiated by cadaveric studies. [ 14 15 16 ] However, there has been a slight discrepancy between the findings established by sonographic studies and those of the cadavers, possibly because these studies have been done in different populations. [ 10 11 12 13 14 15 ] The present study, however, does not use ultrasound findings of the posterior circumflex humeral artery as a guide to course out the axillary nerve because the prime motive of the workers in this study is to establish an affordable cum accessible protocol of a series of safe injection points based on the results of this study for health care workers not only working in tertiary care hospitals with access to ultrasound but also for those workers who deal with vaccinations or therapeutic injections in rural health centers or community health centers where ultrasound is either not accessible or not affordable.…”

“…Some workers have compared the course of the posterior circumflex humeral artery via ultrasound to serve as a route to localize the axillary nerve’s course. [ 14 15 16 ] However, there are still others who have suggested that the posterior circumflex humeral artery need not always accompany the nerve, especially regarding its anterior division as the artery enters the axilla from a posterior aspect. [ 15 16 17 ] These findings have also been further substantiated by cadaveric studies.…”

“…[ 14 15 16 ] However, there are still others who have suggested that the posterior circumflex humeral artery need not always accompany the nerve, especially regarding its anterior division as the artery enters the axilla from a posterior aspect. [ 15 16 17 ] These findings have also been further substantiated by cadaveric studies. [ 14 15 16 ] However, there has been a slight discrepancy between the findings established by sonographic studies and those of the cadavers, possibly because these studies have been done in different populations.…”

“…[ 14 15 16 ] However, there has been a slight discrepancy between the findings established by sonographic studies and those of the cadavers, possibly because these studies have been done in different populations. [ 10 11 12 13 14 15 ] The present study, however, does not use ultrasound findings of the posterior circumflex humeral artery as a guide to course out the axillary nerve because the prime motive of the workers in this study is to establish an affordable cum accessible protocol of a series of safe injection points based on the results of this study for health care workers not only working in tertiary care hospitals with access to ultrasound but also for those workers who deal with vaccinations or therapeutic injections in rural health centers or community health centers where ultrasound is either not accessible or not affordable. Moreover, it is practically not possible for every doctor or nurse or lab personnel working in rural areas or community health centers in this region to use ultrasound every time to localize the branches of axillary nerve across the deltoid before administering injections owing to the large crowds of patients that visit outpatient departments of hospitals every day.…”

Management of Common Football-Related Injuries About the Shoulder

“…Although uncommon, peripheral nerve injuries can be a potentially devastating sports-related injury that may be associated with sensory or motor deficits [91]. Football players are at increased risk, with prior studies demonstrating that between 20% and 30% of all sports-related peripheral nerve injuries occur in American football [62,66,91]. The axillary nerve segment proximal to the quadrilateral space is most frequently associated with shoulder injuries, such as anterior GH joint dislocations and proximal humerus fractures [39,62,85,91,106,114].…”