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Harvey Chim, Michelle F. Kircher, Robert J. Spinner, Allen T. Bishop and Alexander Y. Shin

P ediatric patients with traumatic brachial plexus injuries constitute only a small percentage of all brachial plexus lesions, and consisted of 1.1% of all injuries in a previous patient series. 5 Rarer still are pediatric patients with isolated axillary nerve injuries. These injuries often occur after trauma to the shoulder or less frequently as a complication of shoulder surgery. 15 , 17 They may initially also present with a more extensive pattern of brachial plexus injury, with spontaneous recovery of other components resulting in residual deltoid

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Sangkook Lee, Kriangsak Saetia, Suparna Saha, David G. Kline and Daniel H. Kim

C ontact and low-intensity sports can result in axillary nerve injury, 16 resulting in loss of deltoid function. This muscle is the major abductor of the shoulder. The axillary nerve arises from the posterior cord of the brachial plexus and contains fibers derived from C-5 and C-6 spinal nerve roots via the posterior division of the upper trunk. It passes through the quadrilateral space along with the posterior circumflex artery just distal to the shoulder joint. The nerve then curves around the posterolateral surface of the humerus deep to the deltoid

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Scott L. Zuckerman, Ilyas M. Eli, Manish N. Shah, Nadine Bradley, Christopher M. Stutz, Tae Sung Park and John C. Wellons III

branch passes anteriorly around surgical neck of the humerus and innervates the middle and anterior parts of the deltoid muscle. 10 , 11 , 29 , 47 Damage to the axillary nerve leads to abduction and external rotation weakness. 5 , 29 , 32 Blunt trauma to the shoulder is the most frequent cause of axillary nerve injury, with or without fracture or glenohumeral dislocation. 5 , 7 , 11 , 29 , 38 , 51 Diagnosis is often initially overlooked due to concomitant injuries leading to immobilization and compensatory supraspinatus action. 11 , 39 Injury can be discovered

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Jayme Augusto Bertelli, Paulo Roberto Kechele, Marcos Antonio Santos, Hamilton Duarte and Marcos Flávio Ghizoni

I solated injury to the axillary nerve can occur because of shoulder dislocation or from inadvertent lesions during surgery, or it may be part of a more complex lesion such as a brachial plexus palsy. 2 , 6 , 12 , 18 , 20 , 27 , 30 Axillary nerve injuries lead to abduction and external rotation weakness. 2 , 15 In brachial plexus injuries, shoulder motion is affected in 95% of cases, and the concomitant involvement of the axillary and suprascapular nerves, due to root lesions, culminates in total palsy on abduction and external rotation. 1 In isolated

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Vicente Vanaclocha, Juan Manuel Herrera, Marlon Rivera-Paz, Deborah Martínez-Gómez and Leyre Vanaclocha

Axillary nerve injury is common after brachial plexus injuries, particularly with shoulder luxation. Nerve grafting is the traditional procedure for postganglionic injuries. Nerve transfer is emerging as a viable option particularly in late referrals. At the proximal arm the radial and axillary nerves lie close by. Sacrificing one of the triceps muscle nerve branches induces little negative consequences. Transferring the long head of the triceps nerve branch is a good option to recover axillary nerve function. The surgical technique is presented in a video, stressing the steps to achieve a successful result.

The video can be found here:

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R. Shane Tubbs, Elizabeth C. Tyler-Kabara, Alan C. Aikens, Justin P. Martin, Leslie L. Weed, E. George Salter and W. Jerry Oakes

I solated axillary nerve injuries make up as many as 6% of all brachial plexus injuries. 21 The axillary nerve, or circumflex nerve, is one of the two terminal branches of the posterior cord of the brachial plexus; the radial nerve is the second. Usually, the axillary nerve contains fibers from C-5 and C-6 ventral rami. This nerve innervates the teres minor and deltoid muscles, skin over the shoulder (upper lateral brachial nerve), and the glenohumeral joint. 22 Traveling posteriorly, the axillary nerve enters and traverses the QS, or foramen of Velpeau. 19

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David G. Kline and Daniel H. Kim

than the axillary nerve injury. In these cases, the electromyogram did not reveal any denervational charge in the deltoid muscle. When there were associated injuries to other plexus elements, the loss of deltoid function was sometimes attributed to a plexus level more proximal than the axillary nerve itself. Repetitive clinical and electromyographic sampling, however, usually identified the deltoid paralysis as secondary to a more distal axillary nerve involvement. Preoperatively, the apparent recovery of axillary distribution sensation over the cap of the shoulder

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H. Carson McKowen and Rand M. Voorhies

, 1984 , Vol 4 , pp 38 – 39 Dyck PJ, Low PA, Stevens JC: Diseases of peripheral nerves, in Baker AB, Baker LH (eds): Clinical Neurology. Philadelphia: Harper and Row, 1984, Vol 4, pp 38–39 6. Johnson EW : Axillary nerve injury. Arch Neurol 41 : 1022 , 1984 Johnson EW: Axillary nerve injury. Arch Neurol 41: 1022, 1984 7. Reddy MP : Nerve entrapment syndromes in the upper extremity contralateral to amputation. Arch Phys Med Rehabil 65 : 24 – 26 , 1984 Reddy MP: Nerve entrapment

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R. Shane Tubbs, W. Jerry Oakes, Jeffrey P. Blount, Scott Elton, George Salter and Paul A. Grabb

. Am J Anat 23: 285–395, 1918 7. Petrucci FS , Morelli A , Raimondi PL : Axillary nerve injuries—21 cases treated by nerve graft and neurolysis. J Hand Surg (Am) 7 : 271 – 278 , 1982 Petrucci FS, Morelli A, Raimondi PL: Axillary nerve injuries—21 cases treated by nerve graft and neurolysis. J Hand Surg (Am) 7: 271–278, 1982 8. Samardzic M , Grujicic D , Antunovic V , et al : Reinnervation of avulsed brachial plexus using the spinal accessory nerve. Surg Neurol 33 : 7 – 11

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R. Shane Tubbs, Charles A. Khoury, E. George Salter, Leslie Acakpo-Satchivi, John C. Wellons III, Jeffrey P. Blount and W. Jerry Oakes

F lexion of the elbow and abduction of the shoulder are essential to the ability to manipulate items and feed oneself. 6 Therefore, restoring these functions after brachial plexus injury is a main goal in neurotization of this area. 5 In cases of isolated musculocutaneous or axillary nerve injury in which a primary reanastomosis is not possible, intersegmental graft or neurotization procedures are performed. As a candidate nerve for grafting or neurotization in these cases the LSN has not been explored specifically ( Fig. 1 ). This branch of the