Combined Injuries of the Axillary and Suprascapular Nerves Due to a Closed Nondislocating Rugby Injury: A Case Report

Abstract

　Axillary nerve palsy is commonly associated with shoulder dislocations or fractures; however, cases of axillary nerve injury without these conditions have also been reported. Herein, we report a case of combined injuries of the axillary and suprascapular nerves due to a nondislocating rugby injury. A 21-year-old male was tackled on his left shoulder and experienced persistent limitations in shoulder elevation. Neurolysis of the subclavicular brachial plexus and nerve transfer were performed three months after the injury. The axillary nerve was damaged over a length of 10 cm and intraoperative nerve stimulation confirmed the absence of compound muscle action potentials in the deltoid muscle. Consequently, the radial nerve motor branch to the long head was transferred to the anterior branch of the axillary nerve. Thirty-one weeks post-surgery, the patient regained deltoid muscle strength (grade MMT5) and improved shoulder function, allowing him to return to playing rugby. A systematic review of axillary nerve injury suggested that there were not significant differences in functional outcomes between nerve grafts and nerve transfers; however, nerve transfer is simpler and faster, with no donor-site morbidity and quicker reinnervation. Nerve transfer may be considered a viable treatment option for axillary nerve injury resulting from nondislocating shoulder injuries in contact sports.