Disclosures: Daniel T. Probst, MD: Nothing to disclose

Case Description: The athlete tackled an opponent and experienced the immediate onset of numbness, tingling, and weakness throughout his left arm. He denied shoulder dislocation and his sensory symptoms improved. He finished the season with persistent left shoulder weakness. At presentation to our institution 5 months post-injury, physical exam revealed significant atrophy of the left deltoid muscle with decreased left shoulder abduction strength and decreased sensation over the left deltoid.

Setting: Academic medical center

Patient: High school football athlete with left deltoid weakness and atrophy.

Assessment/Results: EMG demonstrated fibrillation potentials without motor units in the left anterior and middle deltoid heads consistent with complete denervation. In the posterior deltoid head, fibrillation potentials and motor units were present indicating denervation with some spontaneous reinnervation. The teres minor muscle was normal. A shoulder MRI confirmed subacute to chronic deltoid denervation and an unaffected teres minor muscle suggesting an isolated injury to a branch of the axillary nerve. The patient was urgently referred to a plastic surgeon with expertise in nerve injury (SEM). Approximately 6 months post-injury, the patient underwent a medial triceps nerve to axillary nerve transfer. After appropriate post-surgical therapy, the athlete returned to football the following season.

Discussion: Early identification and localization via EMG of peripheral nerve injuries in athletes is crucial. When performed within 3-6 months of a peripheral nerve injury, nerve transfers can lead to significant recovery. However, surgical outcomes diminish after a protracted time of injury, typically around 6 months. When diagnosed, our patient was 5 months post-injury with no visible voluntary motor units in 2 of the 3 heads of his left deltoid. The timing of his surgery likely contributed to his recovery.

Conclusion: An isolated injury to a branch of the axillary nerve was identified, localized via EMG, and successfully treated with a medial triceps nerve to axillary nerve transfer.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-diagnosis-and-treatment-of-an-isolated-axillary-nerve-injury-in-an-elite-high-school-american-football-athlete-a-case-report/