Purpose
To investigate the incidence of axillary nerve palsy after arthroscopic shoulder stabilization
and to measure the distance between the nerve and capsule in shoulders with a capsular
lesion.
Methods
This retrospective study included 2,027 shoulders (1,909 patients; 1,433 male and
476 female patients; mean age, 32 years [age range, 13-81 years]) subjected to arthroscopic
soft-tissue stabilization for recurrent shoulder instability from 2005 to 2017. The
exclusion criteria were bone grafting or transfer and preoperative axillary nerve
symptoms. We retrospectively reviewed patient records and investigated the incidence
and clinical features of axillary nerve palsy. We measured the closest distance between
the axillary nerve and capsule on preoperative magnetic resonance images.
Results
Postoperative axillary nerve palsy occurred in 4 shoulders (0.2% of all arthroscopic
stabilizations). Capsular repair was performed in 2 shoulders (1.2% of 160 capsular
repairs); humeral avulsion of the glenohumeral ligament (HAGL) repair, 1 shoulder
(2% of 47 HAGL repairs); and isolated Bankart repair, 1 shoulder (0.05% of 1,941 Bankart
repairs). The closest distance between the nerve and capsule was 3.4 ± 3.2 mm in shoulders
with capsular or HAGL lesions and less than 1 mm in the 3 shoulders with palsy. The
common symptoms in axillary nerve palsy cases were shoulder discomfort, delayed recovery
of range of motion, and deltoid weakness and atrophy. A definitive diagnosis was made
with electromyography in all cases. Nerve injury by a suture was confirmed during
revision surgery in 3 shoulders subjected to capsular or HAGL repair during the initial
operation. The palsy was transient and fully recovered in 1 shoulder with isolated
Bankart repair.
Conclusions
The incidence of axillary nerve palsy after arthroscopic soft-tissue shoulder stabilization
was low but higher in shoulders subjected to capsular or HAGL repair. We should always
consider the possibility of axillary nerve palsy in shoulders that require capsular
or HAGL repair.
Level of Evidence
Level IV, therapeutic case series.
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Article info
Publication history
Published online: February 25, 2020
Accepted:
February 8,
2020
Received:
August 11,
2019
Footnotes
The authors report the following potential conflicts of interest or sources of funding: H.S. participates in speaker’s bureaus or paid presentations for DePuy Synthes, Smith & Nephew, and Zimmer Biomet, outside the submitted work. K.M. receives grant support from Exactech and Arthrex, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2020 by the Arthroscopy Association of North America
