AXILLARY NERVE

PALSY
• The Axillary nerve (circumflex nerve), is an upper extremity nerve,
which is part of the posterior cord (C5-C6), and provides motor
innervation to the deltoid and teres minor muscles.
CAUSE:
An axillary nerve injury is characterized by trauma to the axillary
nerve: from either a compressive force, a traction injury following
anterior dislocation of the shoulder,or a forced Abduction movement
of the shoulder joint
• Anterior or inferior dislocation of humeral head
• Fracture of surgical neck or the humerus
• Forced Abduction of the shoulder
• Falling on outstretched hand (FOOSH injury)
• Of all brachial plexus injuries, axillary nerve palsy is quite rare,
represents only 3% to 6% of all brachial plexus pathologies.
• Anterior shoulder dislocation is the most common occurring
dislocation at the shoulder,which can cause direct trauma
(compression or traction) to the axillary nerve.
AXILLARY NERVE INJURY
MECHANISM
SIGNS AND SYMPTOMS
• An axillary nerve injury can cause signs and symptoms of a localized 
neuropathy. Signs and symptoms may include:
• Pain to the area of the deltoid and anterior shoulder
• Loss of movement and/or lack of sensation in the shoulder area
• Reported or observed weakness to the deltoid and teres minor muscles
(Abduction and external rotation).
• A true axillary nerve injury (mononeuropathy -involving a single
nerve), should not present with any changes to the local reflexes.
• The axillary nerve is susceptible to injury at several sites, including
the origin of the nerve from the posterior cord, the anterior inferior
aspect of the subscapularis muscle and shoulder capsule, the
quadrilateral space, and within the subfascial surface of the deltoid
muscle
AXILLARY NERVE ENTRAPPED IN
QUADRANGULAR INTERMUSCULAR
SPACE
• TYPE OF AXILLARY NERVE INJURY:
• NEUROPRAXIA
• AXONOTMESIS
• NEUROTMESIS
Subjective Examination

•Generalized mild, dull, and achy pain to the deep or lateral or

anterior shoulder, with occasional radiation to the proximal arm.

•Numbness and tingling of the lateral arm and/or posterior aspect of

the shoulder (C5-C6 nerve root territory) in some cases, persisting 2-4
weeks post-injury.

•Feeling of instability of the shoulder .

•Weakness, especially with flexion, abduction, and external rotation.
•Fatigue, especially with overhead activities, heavy lifting, and/or
throwing.
•May/or may not reveal a history of trauma to the shoulder region]
•History of dislocation with soreness persisting ~1week post-injury.
•Easing factors include: rest (arm supported), ice, analgesics, and anti-
inflammatory medications. 

Many athletes with an axillary nerve injury may be asymptomatic with

incomplete or complete lesions, with the only complaints of weakness and
early-onset fatigue with exercise. 
On observation
Atrophy and wasting of deltoid may be present
Objective examination:
SENSATION TESTING:May be affected in lower part of deltoid region.
ROM:Shoulder abduction and lateral rotation may be restricted
MMT of rotator cuff muscles:deltoid,teres minor may be affected

SPECIAL TEST FOR SHOULDER INSTABILITY:

SULCUS SIGN,Apprehension test,jobe relocation test may be postive
DIAGNOSIS
• CLINICAL SIGNS
• MRI
• EMG,NCV
SURGICAL RX
• Suspicion of osteophyte formation or compression in the quadrilateral
space.
• No axillary nerve recovery observed by 3 to 4 months following
injury.
• No improvements were seen after 3 to 6 months of conservative
treatment.
• No EMG/NCV evidence of recovery by 3 to 6 months after injury.
• NEURORAPPHY
• NEUROTIZATION
• NERVE GRAFTING
PT MX-UPTO 2 WEEKS
• Shoulder immobilization via sling after reduction. There is insufficient evidence to
support whether physical therapy should be initiated during or after immobilization. 
• Isometric Strengthening; Dosing: 10 seconds X 6 repetitions X 2 day within limits of
pain.
• Joint Mobility:
• Passive Range of Motion (PROM): Flexion, Extension, Abduction, Adduction,
Internal Rotation.
• Active Range of Motion (AROM) of all shoulder movements (except external
rotation), when pain is maintained at 3/10 or less; Dosing 10 repetitions X 2 day
• Elbow (Flexion, Extension,Pronation, Supination)
• Wrist (Flexion, Extension, Radial/Ulnar deviation)
• Hand (Opening/Closing Fist)
2-4 WEEKS
• Joint Mobility
• Passive/Active Assisted Range of Motion (PROM/AAROM); Dosing 10
repetitions X 2 day: Shoulder (Flexion, Internal Rotation, Adduction)
• Avoid end-range ER/ABD until later stages of treatment!
• Active Range of Motion (AROM); Dosing 10 repetitions X 2 day:
• Elbow(Flexion, Extension ,Pronation, Supination);
• Wrist (Flexion, Extension, Radial/Ulnar deviation);
• Hand (Opening/Closing Fist)
• Pendulum Exercises 3 sets x 30 seconds for the glenohumeral joint
• Strengthening:rhomboids,serratus ant
4-6 WEEKS
• Srengthening Program light resistive exercises 
• Target muscles: Deltoids, Rotator Cuff muscles, Postural muscles
• Proprioceptive Techniques  PNF diagonals
• Closed Chained Activities:
• Wall push-ups -->Table-->Floor
• Weight Shifts
• 6 weeks-Discharge 
• Continue ROM, glenohumeral and scapulothoracic
stabilization/strengthening exercises, proprioception, and joint
mobility, while maintaining optimal conditions for tissue healing
POST SURGICAL PT MX:
PAIN RELIEF:TEMS,ICE THERAPY
ROM EXS GRADUALLY
GRADUALLY STRENGTHENING OF SCAPULAR AND ROTATOR
CUFF MUSCLES.