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Axillary Nerve Palsy S44.30XA 955.0

deltoid atrophy picture

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ICD-9 Classification / Treatment
Etiology / Natural History Associated Injuries / DDx
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

synonyms:

Axillary Nerve Palsy ICD-10

A- initial encounter

D- subsequent encounter

S- sequela

 

Axillary Nerve Palsy ICD-9

  •  955.0 injury to peripheral nerve of shoulder girdle and upper limb; Axillary nerve

Axillary Nerve Palsy Etiology / Epidemiology / Natural History

  • Etiology: Iatrogenic from open or arthroscopic shoulder surgery; injury during anterior shoulder dislocation or proximal humerus fracture.

Axillary Nerve Palsy Anatomy

  • Terminal branch of posterior cord derived from ventral rami 5&6
  • Runs anterior to subscapularis
  • Enters quadrilateral space with posterior humeral circumflex artery
  • In contact with inferior joint capsule.
  • Branches into anterior trunk{ant 2/3 deltoid} posterior trunk{post 1/3 deltoid,teres minor}
  • Anterior trunk lies 4-7cm inferior to anterolateral acromion.
  • Motor innervation: deltoid, teres minor
  • Sensory innervation: lateral aspect of shoulder in a chevron distribution.
  • Arthroscopic visualization of the axillary nerve (Paribelli G, Arthroscopy 2005:21:1016).
  • See also Shoulder anatomy.

Axillary Nerve Palsy Clinical Evaluation

  • Evaluate and grade anterior, middle and posterior deltoid function. (0-5/-)
  • Document axillary nerve sensation in chevron distribution on shoulder.

Axillary Nerve Palsy Xray / Diagnositc Tests

  • Shoulder xrays indicated to rule out concomittant injury.
  • EMG indicated if no recovery is noted after 2 months of observation.
  • Consider MRI-arthrogram for patients who have failed to improve with observation to rule out associated RTC tear etc.

Axillary Nerve Palsy Classification / Treatment

  • Initial treatment = observation
  • Follow-up at 6-8 weeks. If no recovery is noted on exam, EMG is indicated. EMG must include entire brachial plexus ie suprascapular nerve.
  • It EMG done at two months shows signs of persistent denervation grafting of the axillary nerve should be consider and is best performed within 3-4 months from injury. (Bonnard C, JBJS 1999;81B:212).
  • Vitamin B supplementation may improve recovery from nerve injury.

Axillary Nerve Palsy Associated Injuries / Differential Diagnosis

Axillary Nerve Palsy Complications

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Axillary Nerve Palsy Follow-up Care

Axillary Nerve Palsy Review References

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