[Surgical management of traumatic lesions of the axillary nerve: 83 cases]

Axillary nerve injuries still go undiagnosed far too often despite their frequency. However the quality of the outcome depends on expert management and prompt surgery. To optimise the latter, we re-examined 83 operated cases of traumatic lesions of the axillary nerve. We analysed the neurological and functional recovery of these patients by means of a follow-up evaluation at 6 years postop. The results were classified by age, mechanism of injury, delay to surgery and the presence or otherwise of associated neurological or osteo-articular lesions. We highlighted that a high index of suspicion ought to exist in all cases of trauma to the shoulder in a patient aged more than 40, any injury associated with palsy of the long head of triceps and in the case of an osteo-articular lesion due to high-velocity trauma. A complete lack of shoulder abduction must always prompt a search for a lesion of the axillary nerve as well as a suprascapular nerve palsy or rotator cuff lesion. There are few literature reports of surgical management of this particular nerve injury. An early MRI scan as part of the management should improve results by a reduction in the delay before surgery. As a result of our investigation we conclude that a lesion of the axillary nerve without signs of recovery at 3 months should be referred to a centre specialized in peripheral nerve surgery.