Axillary Nerve Injury Shoulder Dislocation - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describing injury to the axillary nerve associated with shoulder dislocation.
The axillary nerve is the most commonly injured nerve due to shoulder dislocation. It occurs in about 5% of shoulder dislocations. After shoulder dislocation, the patient will be unable to abduct the shoulder, and the deltoid will have no muscle tone.
The supraspinatus muscle will be firing. There will be decreased sensation or absence of sensation on the area of the lateral shoulder. If the patient is older, the inability to abduct the shoulder may be attributed to tear of the rotator cuff, which is common in that age group with shoulder dislocation. This can be a confusing scenario. Rule out a rotator cuff tear. Examine the shoulder sensation.
The intact rotator cuff muscle may abduct the shoulder and confuse the examiner. It is important to check the sensation over the skin of the shoulder. It does not matter if the rotator cuff is intact or torn. The sensation over the skin of the lateral shoulder will tell you if there is axillary nerve palsy or not. Injury of the axillary nerve varies from neuropraxia to complete tear of the nerve.
The axillary nerve passes over the subscapularis and then curves backwards below it and underneath the shoulder joint capsule to enter the quadrangular space.
Within the quadrangular space, the axillary nerve is accompanied by the posterior circumflex humeral artery. This artery is important because it is believed that this artery is the main blood supply to the humeral head. After passing through the quadrangular space, the axillary nerve divides into anterior and posterior divisions. The anterior division curves anterior under the deltoid muscle. The deltoid muscle is innervated by this anterior division of the axillary never. The posterior division supplies the teres minor muscle and the remaining posterior portion of the deltoid muscles as well as the skin over the shoulder. The anterior branch of the axillary nerve is located 5-7 cm distal to the lateral edge of the acromion. Do not exceed deltoid splitting approach more than 5 cm below the acromion or you risk injury to the axillar nerve. During surgery, adduction and external rotation moves the nerve away from the surgical field.
What do you do when the axillary nerve is injured?
• Give the patient a sling for comfort.
• Physical therapy
• Follow the patient’s progress clinically (usually the nerve will recover).
• Get EMG and nerve studies
o Biphasic waveforms will be seen at 3-4 weeks if the nerve recovers.
• If the nerve does not recover:
o You will get fibrillation potentials and P-waves.
• Failure to abduct the shoulder after 4-6 months despite physical therapy means that the condition is permanent and the patient may not achieve abduction of the shoulder without recovery of the deltoid muscle (too late for deltoid to recover).
• Since the intact rotator cuff muscle failed to abduct the shoulder and to take over the job of the deltoid muscle, then this condition is permanent.
When the condition is permanent you have two options:
• Exploration of the nerve for release, repair, or reconstruction of the nerve (reconstructed by a nerve graft).
• Do a tendon transfer.
o Transfer of the trapezius to the proximal humerus.
o The result of this transfer is usually poor.
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[@madman026]

this guy is amazing 2 years i went thru this crap my doctors is clueless he explains it in 4 mins

[@josephdanielsmith6179]

All these videos are excellent production. Thanks!

[@markrobinson1909]

very helpful video, thanking you from the bottom of my heart

[@chuckgame4210]

very informative and helpful. Good graphics and English.

[@ashiqiraqi]

Thank you for this great information

[@ahmedassaad1]

Thank you very much Dr. Nabil, you're the best and your videos are very helpful. GOD bless you

[@robinsturgis5733]

Thanks for the information it has really helped us understand the upcoming surgery

[@alessandran06]

learning more and more from you!

[@Fionagoode6996]

Thank you!

[@arijitdhar71]

please prepare a video on CTEV..

[@hussainalhamal6155]

is the axillary nerve injury indication for acute surgery

[@LilLeo67]

I had a shoulder injury without a dislocation. I slipped & my bf tried to keep me from falling. He pulled my arm up & accidentally pulled me off my feet by my arm. It wasn’t strong enough to hold my body weight. I suspected a brachial plexus strain but could I have injured the axillary artery without a shoulder dislocation?

[@andremedcraft27]

Dislocated left shoulder 5 days ago. Still have pins and needles all down back of my forearm and front to my little finger. Hoping it stops soon as my whole arm feels like it’s freezing cold. My follow up hospital appointment is another week away.

[@abhijithnandakumar9576]

Bro how is it now?.. same happened to me few days back

[@tnullmeyer]

how are you now??

[@jonezy6056]

I dislocated my shoulder almost 2 months ago and still have weakness in shoulder and inability to lift arm above parallel with floor. But no loss of sensation. MRI shows only a small tear in rotator cuff. Could this be nerve damage? I have EMG scheduled but not for another month (3 months post injury). Is this too long to wait for EMG results? Thanks

[@johniorio7951]

I think my axillary nerve is doing better after 2 weeks of pain. My cure is to lay off any stress on the left arm, i avoid lifting anything heavy, and sleep on my right shoulder....i am letting nature be the doctor......I am surprised at how long it is taking, but then, i am now 60

[@vikasvivek2256]

Sir how to repair axillary nerve injury

[@kkevents4437]

Vikas Vivek give me a your Mobile no.

[@manojkumarpradhan44]

I am injure auxillary nerve please repair your contact number send

[@cicciuzzu5032]

What does it mean that the supraspinatus will be firing???

[@decadams5560]

My problem with my shoulder is when I was coming down on the pull up bar my shoulder locked out and felt like deltoid in-caved itself like it it was dislocated but it wasn’t that, I feel like I’ll never be able to recover from it, it started when I was fighting on holiday by just punching someone.. then about a year later I came down on the pull up bar and the same thing happened :/ worst pain in my life

[@thatnigga1995]

How’s your shoulder now

[@decadams5560]

@@thatnigga1995 had surgery 2 year ago…. It’s 75 - 85 % working the way it should… had a block put in there due to lesion on the humeral head due to the acromion going into it as I’ve came down on the pull up bar if you get me…

[@salitsangma6836]

Sir yesavala bimari ke kya dava sir?

[@jasonwillis9202]

I’m dealing with this injury right now it’s terrible. My shoulder detoriated in a week. I read that it can grow back by itself who knows.

[@stevenjonas1]

It's been one year since you left this comment, how has it come along?? Any change in the mass of your deltoid?

[@tetricko]

Did u recover fully?

[@tetricko]

@@qdpqbp i still have not recovered and i dont know what to do

[@tetricko]

@@qdpqbp no they just make way for it to not be irritated but its not a ln easy surgery

[@mr.grumpy3683]

It took me about 2yrs to get back. There was also frozen shoulder b/c nerve pain was so hard.

[@alwonner]

It’s not the “LONG HEAD OF BICEPS but well the SHORT HEAD of biceps in the quadrangular space....

[@mjclaudianava5397]

Triceps*