Isolated Axillary Nerve Injury in an Elite High School American Football Player: A Case Report

Determination of safe sites of intramuscular arm injections and its relevance to the community

Background and Introduction

Intramuscular injections are usually given in the arm or the gluteal region. Needle insertions done through the intramuscular route in the arm are almost always administered at a point 1 - 2 cm above the insertion of the deltoid. However, this site is not such an ideal one as found by certain other workers. Hence, this study was done to establish a series of safe determinant points in and around the arm in the South Indian population of the state of Telangana.

Materials and Methods

The five proven safe injection points were tested through needle insertions by observing sterile aseptic precautions in the arms of 370 subjects at the outpatient department of a national level medical research institute after obtaining their consent following the universal safety protocol.

Results

The points I [1 to 2 cm above deltoid insertion], II [a point midway between the midpoint of arm and insertion of deltoid] and III [midpoint between anterior acromion and deltoid insertion] were found to be safe for administering intramuscular arm injections in this subset of the population.

Conclusion

This explains the erratic course of the anterior branches of the axillary nerve in different geographical populations. Hence, needle insertion points for arm intramuscular injections need to be determined according to the region.

Isolated axillary nerve palsy after liposuction, an exceptional complication

Isolated injury to the axillary nerve associated with the patient's surgical position is a very rare complication, and in most cases it is associated with the prone during spinal surgery. The presentation of this pathology in relation to surgeries of another nature is exceptional, with only a few cases in the scientific literature. We present the case of a patient who developed symptoms of isolated left axillary nerve palsy after undergoing lipoabdominoplasty and breast reduction, in which the prone and supine positions were alternated. The use of an infiltration solution with lidocaine and epinephrine could have contributed to the appearance of the lesion in this unique case. Finally, the clinical picture was fully resolved thanks to conservative treatment.

Isolated axillary nerve palsy after liposuction, an exceptional complication

Isolated injury to the axillary nerve associated with the patient́s surgical position is a very rare complication, and in most cases it is associated with the prone during spinal surgery. The presentation of this pathology in relation to surgeries of another nature is exceptional, with only a few cases in the scientific literature. We present the case of a patient who developed symptoms of isolated left axillary nerve palsy after undergoing lipoabdominoplasty and breast reduction, in which the prone and supine positions were alternated. The use of an infiltration solution with lidocaine and epinephrine could have contributed to the appearance of the lesion in this unique case. Finally, the clinical picture was fully resolved thanks to conservative treatment.

Quadrangular Space Syndrome: A Narrative Overview

OBJECTIVE

The purpose of this narrative review of the literature is to provide an overview of quadrangular space syndrome with special attention to its clinical presentation, differential diagnosis, and treatment.

METHODS

A narrative review of the English-language, peer-reviewed literature was performed using the key words "axillary nerve," "quadrangular space," "quadrilateral space," and "posterior humeral circumflex artery." Databases searched were Medline Complete, Cumulative Index to Nursing and Allied Health Literatures, and Index to Chiropractic Literature. The search period was from 1983 through January 2020.

RESULTS

There were 85 articles selected for this review. A summary and overview are provided.

CONCLUSION

Quadrangular space syndrome is an uncommon cause of shoulder pain. Clinicians should consider it as a diagnosis after ruling out more common shoulder conditions and examining other concurrent diseases.