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McCarthy A, O'Neill B. COVID-19 Vaccines and Axillary Nerve Dysfunction: A Case Report. Cureus 2023; 15:e49269. [PMID: 38143650 PMCID: PMC10746867 DOI: 10.7759/cureus.49269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
COVID-19 resulted in a worldwide pandemic and the rapid introduction of vaccines in an attempt to mitigate it. Neuritis and neuropathy after intramuscular injection had been previously seen with influenza vaccines and appear to be a side effect of the COVID-19 vaccine as well. In the following report, we present the case of a 43-year-old female who developed axillary nerve symptoms after administration of the COVID-19 vaccine and her subsequent recovery.
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Affiliation(s)
- Andrea McCarthy
- Trauma and Orthopedic Surgery, St. James's Hospital, Dublin, IRL
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Loren J, Lu CY(J, Yang CP, Hsu KY, Cheng YH, Sheu H, Chen CY, Tang HC, Chuang CA, Chiu CH(J. Arthroscopic Lower Trapezius Tendon Transfer for a Patient with Axillary Nerve Injury and Concomitant Rotator Cuff Tear: A Case Report and Technical Notes. Medicina (Kaunas) 2023; 59:1817. [PMID: 37893536 PMCID: PMC10608587 DOI: 10.3390/medicina59101817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
Introduction: Concomitant nerve injuries with musculoskeletal injuries present a challenging problem. The goals of nerve reconstruction for the shoulder include shoulder abduction and external rotation. When patients fail to achieve acceptable shoulder external rotation and shoulder abduction, tendon transfers such as trapezius transfer offer a reliable option in the subsequent stage. Case Presentation: A 32-year-old male presented with weak external rotation in his left shoulder, after previous axillary nerve reconstruction. He received the ipsilateral lower trapezius transfer with the aim of improving the external rotation. Discussion: The lower trapezius restores a better joint reaction force in both the compressive-distractive and anterior-posterior balancing and provides a centering force through the restoration of the anterior-posterior force couple. Conclusion: We believe that the ipsilateral lower trapezius transfer to the infraspinatus is a good outcome and is effective in improving overall shoulder stability and the shoulder external rotation moment arm or at least maintaining in neutral position with the arm fully adducted in patients with post axillary nerve injuries post unsatisfactory nerve reconstruction to increase the quality of life and activities of daily living.
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Affiliation(s)
- Jeff Loren
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.L.); (C.-P.Y.); (C.-Y.C.)
- Department of Orthopedics & Traumatology, Royal Prima General Hospital, Medan 20118, Indonesia
| | - Chuieng-Yi (Johnny) Lu
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Cheng-Pang Yang
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.L.); (C.-P.Y.); (C.-Y.C.)
| | - Kuo-Yao Hsu
- Department of Orthopedic Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan; (K.-Y.H.); (Y.-H.C.)
| | - You-Hung Cheng
- Department of Orthopedic Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan; (K.-Y.H.); (Y.-H.C.)
| | - Huan Sheu
- Department of Orthopedic Surgery, Taoyuan Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
| | - Chao-Yu Chen
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.L.); (C.-P.Y.); (C.-Y.C.)
| | - Hao-Che Tang
- Department of Orthopedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; (H.-C.T.); (C.-A.C.)
| | - Chieh-An Chuang
- Department of Orthopedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; (H.-C.T.); (C.-A.C.)
| | - Chih-Hao (Joe) Chiu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.L.); (C.-P.Y.); (C.-Y.C.)
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Sousa D, Reis J, Guimarães A, Lemos Lopes A. Simultaneous Bilateral Anterior Shoulder Dislocation After Low-Energy Trauma: A Case Report. Cureus 2023; 15:e43852. [PMID: 37736445 PMCID: PMC10510745 DOI: 10.7759/cureus.43852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
Unilateral shoulder dislocation is known to be one of the most common joint dislocations. However, simultaneous bilateral shoulder dislocations are rare, especially anterior dislocations. We report a case of an 84-year-old woman who presented to the urgency room with symmetrical bilateral anterior shoulder dislocation 12 hours after falling on a treadmill. She presented with bilateral pain, functional impairment, prominent acromion, flattened shoulder, and, in the right upper limb, paresthesias on the dorsum of the hand and extension deficit of the fingers. Closed reduction of both shoulders was performed under sedation, and she was immobilized bilaterally with an arm sling in internal rotation. A full recovery was achieved six months after the injury.
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Affiliation(s)
- Diogo Sousa
- Orthopaedics and Traumatology, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, PRT
| | - João Reis
- Orthopaedics and Traumatology, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, PRT
| | - André Guimarães
- Orthopaedics and Traumatology, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, PRT
| | - António Lemos Lopes
- Orthopaedics and Traumatology, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, PRT
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Couch BK, Maher PL, Fourman MS, Moloney GB, Siska PA, Tarkin IS. Increased Medial Displacement of the Humeral Shaft of at Least 40% Correlates With an Increased Incidence of Nerve Injury in Proximal Humerus Fractures. Iowa Orthop J 2021; 41:163-166. [PMID: 34552419 PMCID: PMC8259169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Peripheral nerve and infraclavicular brachial plexus injury following proximal humerus fractures are commonplace, but diagnosing a concomitant nerve injury in the acute setting is challenging. Fracture displacement has been identified as a qualitative risk factor for nerve injury, and additional attention should be paid to the neurologic exams of patients with proximal humerus fractures with significant medial shaft displacement. However, a quantitative relationship between the risk of nerve injury and medialization of the humeral shaft has not been shown, and additional risk factors for this complication have not been assessed. The aim of this study was to identify the risk factors for a neurologic deficit following a proximal humerus fracture, with particular interest in the utility of the magnitude of medial shaft displacement as a predictor of neurologic dysfunction. METHODS A retrospective chart review was performed on all proximal humerus fractures in a 3-year period (2012-2015) at a level one trauma center. Isolated greater tuberosity fractures (OTA 11-A1) were excluded. Fracture displacement was measured on initial injury AP shoulder radiograph and expressed as a percentage of humeral diaphyseal width. All orthopedic inpatient documentation was assessed to identify clinical neurologic deficits. RESULTS We identified 139 patients for inclusion. There were 22 patients (16%) with new neurologic deficits at presentation (8 axillary nerve, 2 radial nerve, 12 infraclavicular brachial plexus or multiple nerve injuries). The average shaft medial displacement in patients with neurologic injuries was 59% vs. 21% without nerve deficits (p=0.03). Using a 40% medial displacement threshold, the odds ratio for a nerve injury was 5.24 (95% CI 1.54 - 17.77, p=.008). CONCLUSION Increased medial displacement of the humeral shaft following proximal humerus fracture is associated with an increased incidence of nerve injury at the time of initial presentation. This finding is not meant to be a surrogate for a high-quality neurologic exam in all patients with proximal humerus fractures. However, improved knowledge of the specific risk factors for an occult neurologic injury will improve the clinician's ability to accurately diagnose and properly treat proximal humerus fractures and their sequelae.Level of Evidence: III.
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Affiliation(s)
- Brandon K. Couch
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Patrick L. Maher
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mitchell S. Fourman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gele B. Moloney
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Peter A. Siska
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ivan S. Tarkin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Diallo M, Kassé AN, Mohamed Limam S, Sané JC, Dembélé B, Sy MH. Erecta dislocation of the shoulder joint-A rare injury: About four cases. Clin Case Rep 2019; 7:1319-1322. [PMID: 31360476 PMCID: PMC6637323 DOI: 10.1002/ccr3.2221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 08/03/2016] [Accepted: 01/26/2017] [Indexed: 11/22/2022] Open
Abstract
A nonresolving axillary nerve injury is a rare associated complication to an inferior dislocation of the shoulder joint. This worsen the midterm outcome of the shoulder. So, neurovascular status must be checked by regular clinical testing and by an electromyography in all cases of inferior dislocation of the shoulder joint.
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Abstract
Introduction: The anterolateral acromion approach of the shoulder is popular for minimally invasive plate osteosynthesis (MIPO) technique. However, there are literatures describing the specific risks of injury of the axillary nerve using this approach. Nevertheless, most of the studies were done with Caucasian cadavers. So, the purpose of this study was to evaluate the risk of iatrogenic axillary nerve injury from using the anterolateral shoulder approach and further investigate the location of the axillary nerve, associated with its location and arm length in the Asian population that have shorter arm length compared to the Caucasian population. Materials and Methods: Seventy-nine shoulders in fourty-two embalmed cadavers were evaluated. The bony landmarks were drawn, and a vertical straight incision was made 5cm from tip of the acromion (anterolateral approach), to the bone. The iatrogenic nerve injury status and the distance between the anterolateral edge of the acromion to the axillary nerve was measured and recorded. Results: In ten of the seventy-nine shoulders, the axillary nerve were iatrogenically injured. The average anterior distance was 6.4cm and the average arm length was 30.2cm. The anterior distance and arm length ratio was 0.2. Conclusion: Our results demonstrated that the recommended safe zone at 5cm from tip of acromion was not suitable with Asian population due to shorter arm length, compared to Caucasian population. The location of axillary nerve could be predicted by 20% of the total arm-length.
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Affiliation(s)
| | - P Wattananon
- Department of Orthopaedics, Lerdsin General Hospital, Bangkok, Thailand
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Abstract
OBJECT Transfer of the triceps motor branch has been used for treatment of isolated axillary nerve palsy in the adult population. However, there are no published data on the effectiveness of this procedure in the pediatric population with traumatic injuries. The authors reviewed demographics and outcomes in their series of pediatric patients who underwent this procedure. METHODS Six patients ranging in age from 10 to 17 years underwent triceps motor branch transfer for the treatment of isolated axillary nerve injuries between 4 and 8 months after the inciting injury. Deltoid muscle strength was evaluated using the modified British Medical Research Council (MRC) grading system. Shoulder abduction at last follow-up was measured. RESULTS The mean duration of follow-up was 38 months. The average postoperative MRC grading of deltoid muscle strength was 3.6 ± 1.3. The median MRC grade was 4. One patient who did not achieve an MRC grade of 3 suffered multiple injuries from high-velocity trauma. Unlike in the adult population, age, body mass index of the patient, and delay from injury to surgery were not significant factors affecting the outcome of the procedure. CONCLUSIONS In the pediatric population with traumatic injuries, isolated axillary nerve injury treated with triceps motor branch transfer can result in good outcomes.
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Affiliation(s)
- Harvey Chim
- Division of Hand Surgery, Department of Orthopedic Surgery, and
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Zuckerman SL, Eli IM, Shah MN, Bradley N, Stutz CM, Park TS, Wellons JC. Radial to axillary nerve neurotization for brachial plexus injury in children: a combined case series. J Neurosurg Pediatr 2014; 14:518-26. [PMID: 25192235 DOI: 10.3171/2014.7.peds13435] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Axillary nerve palsy, isolated or as part of a more complex brachial plexus injury, can have profound effects on upper-extremity function. Radial to axillary nerve neurotization is a useful technique for regaining shoulder abduction with little compromise of other neurological function. A combined experience of this procedure used in children is reviewed. METHODS A retrospective review of the authors' experience across 3 tertiary care centers with brachial plexus and peripheral nerve injury in children (younger than 18 years) revealed 7 cases involving patients with axillary nerve injury as part of an overall brachial plexus injury with persistent shoulder abduction deficits. Two surgical approaches to the region were used. RESULTS Four infants (ages 0.6, 0.8, 0.8, and 0.6 years) and 3 older children (ages 8, 15, and 17 years) underwent surgical intervention. No patient had significant shoulder abduction past 15° preoperatively. In 3 cases, additional neurotization was performed in conjunction with the procedure of interest. Two surgical approaches were used: posterior and transaxillary. All patients displayed improvement in shoulder abduction. All were able to activate their deltoid muscle to raise their arm against gravity and 4 of 7 were able to abduct against resistance. The median duration of follow-up was 15 months (range 8 months to 5.9 years). CONCLUSIONS Radial to axillary nerve neurotization improved shoulder abduction in this series of patients treated at 3 institutions. While rarely used in children, this neurotization procedure is an excellent option to restore deltoid function in children with brachial plexus injury due to birth or accidental trauma.
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Lancaster ST, Smith GC, Ogunleye OE, Clark DA, Packham IN. Proximity of Axillary Nerve During Cortical Button Repair of Pectoralis Major Tendon Rupture. Shoulder Elbow 2014; 6:29-34. [PMID: 27582906 PMCID: PMC4986656 DOI: 10.1111/sae.12044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 08/20/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Rupture of the pectoralis major (PM) tendon is a rare but severe injury. Several techniques have been described for PM fixation, including a transosseus technique, placing cortical buttons at the superior, middle and inferior PM tendon insertion points. The present cadaveric study investigates the proximity of the posterior branch of the axillary nerve to the drill positions for transosseus PM tendon repair. METHODS Twelve cadaveric shoulders were used. The axillary nerve was marked during a preparatory dissection. Drills were passed through the humerus at the superior, middle and inferior insertions of the PM tendon and the drill bits were left in situ. The distance between these and each axillary nerve was measured using computed tomography. RESULTS The superior drill position was in closest proximity to the axillary nerve (three-dimensional distance range 0-18.01 mm, mean 10.74 mm, 95% confidence interval 7.24 mm to 14.24 mm). The middle PM insertion point was also very close to the nerve. CONCLUSIONS Caution should be used when performing bicortical drilling of the humerus, especially when drilling at the superior border of the PM insertion. We describe 'safe' and 'danger' zones for the positioning of cortical buttons through the humerus reflecting the risk posed to the axillary nerve.
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Affiliation(s)
- Sarah T. Lancaster
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK,
Correspondence: Musculoskeletal Research Unit, Avon Orthopaedic Centre, Southmead Hospital, Southmead Road, Bristol BS10 5NB, UK. Tel.: +44 117 323 5966. Fax: +44 117 323 6192. E-mail:
| | - Geoff C. Smith
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
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