Incidence of Axillary Nerve Injury After Arthroscopic Shoulder Stabilization

Published:February 25, 2020DOI:


      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.


      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.


      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.


      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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        • Owens B.D.
        • Harrast J.J.
        • Hurwitz S.R.
        • Thompson T.L.
        • Wolf J.M.
        Surgical trends in Bankart repair: An analysis of date from the American Board of Orthopaedic Surgery certification Examination.
        Am J Sports Med. 2018; 39: 1865-1869
        • Sugaya H.
        • Moriishi J.
        • Kanisawa I.
        • Tsuchiya A.
        Arthroscopic osseous Bankart repair for chronic recurrent traumatic anterior glenohumeral instability.
        J Bone Joint Surg Am. 2005; 87: 1752-1760
        • Abdul-Rassoul H.
        • Galvin J.W.
        • Curry E.J.
        • Simon J.
        • Li X.
        Return to sport after surgical treatment for anterior shoulder instability. A systematic review.
        Am J Sports Med. 2019; 47: 1507-1515
        • Kang R.W.
        • Frank R.M.
        • Nho S.J.
        • et al.
        Complications associated with anterior shoulder instability repair.
        Arthroscopy. 2009; 25: 909-920
        • DeFroda S.
        • Bokshan S.
        • Stern E.
        • Sullivan K.
        • Owens B.D.
        Arthroscopic Bankart repair for the management of anterior shoulder instability: Indications and outcomes.
        Curr Rev Musculoskelet Med. 2017; 10: 442-451
        • Matsuki K.
        • Sugaya H.
        Complications after arthroscopic labral repair for shoulder instability.
        Curr Rev Musculoskelet Med. 2015; 8: 53-58
        • Szyluk K.
        • Jasinski A.
        • Widuchowski W.
        • Mielnik M.
        • Koczy B.
        Results of arthroscopic Bankart lesion repair in patients with post-traumatic anterior instability of the shoulder and a non-engaging Hill-Sachs lesion with a suture anchor after a minimum of 6-year follow up.
        Med Sci Monit. 2015; 21: 2331-2338
        • Ahmed I.
        • Ashton F.
        • Robinson C.M.
        Arthroscopic Bankart repair and capsular shift for recurrent anterior shoulder instability: Functional outcomes and identification of risk factors for recurrence.
        J Bone Joint Surg Am. 2012; 94: 1308-1315
        • Brilakis E.
        • Mataragas E.
        • Deligeorgis A.
        • Maniatis V.
        • Antonogiannakis E.
        Midterm outcomes of arthroscopic remplissage for the management of recurrent anterior shoulder instability.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 593-600
        • Carofino B.C.
        • Brogan D.M.
        • Kircher M.F.
        • et al.
        Iatrogenic nerve injuries during shoulder surgery.
        J Bone Joint Surg Am. 2013; 95: 1667-1674
        • Mishra D.K.
        • Fanton G.S.
        Two-year outcome of arthroscopic Bankart repair and electrothermal-assisted capsulorrhaphy for recurrent traumatic anterior shoulder instability.
        Arthroscopy. 2001; 17: 844-849
        • Wong K.L.
        • Williams G.R.
        Complications of thermal capsulorrhaphy of shoulder.
        J Bone Joint Surg Am. 2001; 83: 151-155
        • Miniaci A.
        • McBirnie J.
        Thermal capsular shrinkage for treatment of multidirectional instability of the shoulder.
        J Bone Joint Surg Am. 2003; 85: 2283-2287
        • D’Alessandro D.F.
        • Bradley J.P.
        • Fleischli J.E.
        • Connor P.M.
        Prospective evaluation of thermal capsulorrhaphy for shoulder instability. indications and results, two-to five-year follow-up.
        Am J Sports Med. 2004; 32: 21-33
        • Athwal G.S.
        • Meislin R.
        • Getz C.
        • Weinstein D.
        • Favorito P.
        Short-term complications of the arthroscopic Latarjet procedure: A North American experience.
        Arthroscopy. 2016; 32: 1965-1970
        • Chuang M.J.
        • Jancosko J.J.
        • Mendoza V.
        • Nottage W.M.
        The incidence of Propionibacterium acnes in shoulder arthroscopy.
        Arthroscopy. 2015; 31: 1702-1707
        • Yeranosian M.G.
        • Arshi A.
        • Terrell R.D.
        • Wang J.C.
        • McAllister D.R.
        • Petrigliano F.A.
        Incidence of acute postoperative infections requiring reoperation after arthroscopic shoulder surgery.
        Am J Sports Med. 2014; 42: 437-441
        • Dhawan A.
        • Ghodadra N.
        • Karas V.
        • Salata M.J.
        • Cole B.J.
        Complications of bioabsorbable suture anchors in the shoulder.
        Am J Sports Med. 2012; 40: 1424-1430
        • Park M.J.
        • Hsu J.E.
        • Harper C.
        • Sennett B.J.
        • Huffman G.R.
        Poly-L/D-lactic acid anchors are associated with reoperation and failure of SLAP repairs.
        Arthroscopy. 2011; 27: 1335-1340
        • Sanders T.G.
        • Zlatkin M.B.
        • Paruchuri N.B.
        • Higgins R.W.
        Chondrolysis of the glenohumeral joint after arthroscopy: Findings on radiography and low-field-strength MRI.
        AJR Am J Roentgenol. 2007; 188: 1094-1098
        • Scheffel P.T.
        • Clinton J.
        • Lynch J.R.
        • Warme W.J.
        • Bertelsen A.L.
        • Matsen III, F.A.
        Glenohumeral chondrolysis: A systematic review of 100 cases from the English language literature.
        J Shoulder Elbow Surg. 2010; 19: 944-949
        • Franceschi F.
        • Papalia R.
        • Del Buono A.
        • Vasta S.
        • Maffulli N.
        • Denaro V.
        Glenohumeral osteoarthritis after arthroscopic Bankart repair for anterior instability.
        Am J Sports Med. 2011; 39: 1653-1659
        • Harris J.D.
        • Gupta A.K.
        • Mall N.A.
        • et al.
        Long-term outcomes after Bankart shoulder stabilization.
        Arthroscopy. 2013; 29: 920-933
        • Ando A.
        • Sugaya H.
        • Takahashi N.
        • Kawai N.
        • Hagiwara Y.
        • Itoi E.
        Arthroscopic management of selective loss of external rotation after surgical stabilization of traumatic anterior glenohumeral instability: Arthroscopic restoration of anterior transverse sliding procedure.
        Arthroscopy. 2012; 28: 749-753
        • Leroux T.
        • Bhatti A.
        • Khoshbin A.
        • et al.
        Combined arthroscopic Bankart repair and remplissage for recurrent shoulder instability.
        Arthroscopy. 2013; 29: 1693-1701
        • Bokor D.J.
        • Raniga S.
        • Graham P.L.
        Axillary nerve position in humeral avulsions of the glenohumeral ligament.
        Orthop J Sports Med. 2018; 5 (2325967118811044)
        • Tirman P.F.
        • Bost F.W.
        • Steinbach L.S.
        • et al.
        MR arthrographic depiction of the rotator cuff: Benefit of abduction and external rotation of the arm.
        Radiology. 1994; 192: 851-856
        • Kon Y.
        • Shiozaki H.
        • Sugaya H.
        Arthroscopic repair of a humeral avulsion of the glenohumeral ligament lesion.
        Arthroscopy. 2005; 21: 632.e1-632.e6
        • Uno A.
        • Bain G.I.
        • Mehta J.A.
        Arthroscopic relationship of the axillary nerve to the shoulder joint capsule: An anatomic study.
        J Shoulder Elbow Surg. 1999; 8: 226-230
        • Price M.R.
        • Tillett E.D.
        • Acland R.D.
        • Nettleton G.S.
        Determining the relationship of the axillary nerve to the shoulder joint capsule from an arthroscopic perspective.
        J Bone Joint Surg Am. 2004; 86: 2135-2142
        • Bryan W.J.
        • Schauder K.
        • Tullos H.S.
        The axillary nerve and its relationship to common sports medicine shoulder procedures.
        Am J Sports Med. 1986; 14: 113-116
        • Esmail A.N.
        • Getz C.L.
        • Schwartz D.M.
        • Wierzbowski L.
        • Ramsey M.L.
        • Williams Jr., G.R.
        Axillary nerve monitoring during arthroscopic shoulder stabilization.
        Arthroscopy. 2005; 21: 665-671
        • Sathasivam S.
        • Lecky B.
        • Manohar R.
        • Selvan A.
        Neuralgic amyotrophy.
        J Bone Joint Surg Br. 2008; 90: 550-553
        • Seror P.
        Neuralgic amyotrophy. An update.
        Joint Bone Spine. 2017; 84: 153-158
        • Wehbe J.
        • Maalouf G.
        • Habanbo J.
        • Chidiac R.M.
        • Braun E.
        • Merle M.
        Surgical treatment of traumatic lesions of the axillary nerve. A retrospective study of 33 cases.
        Acta Orthop Belg. 2004; 70: 11-18