Transient Axillary Neuropraxia in a Collegiate Baseball Pitcher (original) (raw)
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Neurologic Injuries in the Athlete's Shoulder
Journal of Athletic Training, 2000
Objective: To review the presentation, evaluation, treatment, and prognosis of various nerve injuries about the shoulder in the athletic population. Included are injuries to the axillary, suprascapular, musculocutaneous, long thoracic, and spinal accessory nerves. Data Sources: This article represents a review of the literature regarding incidence, presentation, and results of treatment of these various nerve injuries. The clinically pertinent anatomy is also presented to better relate mechanism of injury to the occurrence of nerve injury. I searched MEDLINE from 1966 through 1999 and the Joumal of Shoulder and Elbow Surgery from 1992 through 1999 for the key words "nerve" and "shoulder." Data Synthesis: A historical review of treatment results is presented as well as a review of treatment options and the A thletic injuries to the shoulder most commonly involve the rotator cuff, glenohumeral joint, and acromioclavicular joint. Although less common, peripheral nerve injuries about the shoulder during athletic competition have increased along with the general interest in recreational athletics.1 These injuries may be subtle and are often hard for the clinician to detect. Contact sports such as football and wrestling contribute to most of these injuries, although peripheral nerve injuries to the shoulder have been reported in almost every sport, including bowling, golf, backpacking, and rope skipping.2-4 Poor training techniques and specialization at an early age have contributed greatly to the increase in these injuries.5'6 Injuries to the axillary, suprascapular, musculocutaneous, long thoracic, and spinal accessory nerves produce distinct clinical syndromes about the shoulder.7"11 Early recognition of these injuries by involved medical personnel is critical for the prompt treatment, rehabilitation, and return to sport in these athletes. Nerve injuries can be seen after a forceful traumatic injury or as the result of chronic, repetitive stress.6"2 Patients most often present complaining of pain and weakness, followed in time by atrophy in the affected muscle groups. The severity of nerve injuries increases from neurapraxia to axonotmesis to neurotmesis.8 Fortunately, most peripheral nerve injuries about the shoulder in sports are first-degree injuries, or neurapraxias, consisting of a conduction block in the presence of intact neural elements, including the axons and their connective tissue sheaths. The prognosis for complete recovery in these patients is excellent. Second-degree nerve results of studies using modem techniques in the management of nerve injuries. ConclusionslRecommendations: Nerve injuries about the shoulder present as distinct clinical syndromes, although signs and symptoms can be subtle. The athletic trainer and team physician must be able to recognize the presentation of these injuries so that adequate evaluation and prompt treatment can be instituted to maximize the athlete's chance for early retum to sport.
Nerve injuries about the shoulder in athletes are being recognized with increasing frequency. Prompt and correct diagnosis of these injuries is important to treat the patient and to understand the potential complications and natural history, so as to counsel our athletes appropriately. This 2-part article is a review and an overview of the current state of knowledge regarding some of the more common nerve injuries seen about the shoulder in athletes, including long thoracic nerve, spinal accessory nerve, burners and stingers, and thoracic outlet syndrome. Each of these clinical entities will be discussed independently, reviewing the anatomy, mechanism of injury, patient presentation (history and examination), the role of additional diagnostic studies, differential diagnosis, and management.
Jcca Journal of the Canadian Chiropractic Association Journal De L Association Chiropratique Canadienne, 2009
This report documents retrospectively a case of Posterior Interosseous Neuropathy (PIN) occurring in an elite baseball pitcher experiencing a deep ache in the radial aspect of the forearm and altered sensation in the dorsum of the hand on the throwing arm during his pitching motion. The initial clinical goal was to control for inflammation to the nerve and muscle with active rest, microcurrent therapy, low-level laser therapy, and cessation of throwing. Minimizing mechanosensitivity at the common extensor region of the right elbow and PIN, was achieved by employing the use of myofascial release and augmented soft tissue mobilization techniques. Neurodynamic mobilization technique was also administered to improve neural function. Implementation of a sport specific protocol for the purposes of maintaining throwing mechanics and overall conditioning was utilized. Successful resolution of symptomatology and return to pre-injury status was achieved in 5 weeks. A review of literature and an evidence-based discussion for the differential diagnoses, clinical examination, diagnosis, management and rehabilitation of PIN is presented.
Isolated Axillary Nerve Injury in an Elite High School American Football Player: A Case Report
Sports Health: A Multidisciplinary Approach, 2019
An elite high school American football athlete sustained a traumatic, isolated, axillary nerve injury. Axillary nerve injuries are uncommon, but serious injuries in American football. With the advent of nerve transfers and grafts, these injuries, if diagnosed in a timely manner, are treatable. This case report discusses the multidisciplinary approach necessary for the diagnosis and treatment of an elite high school American football player who presented with marked deltoid atrophy. The athlete’s injury was diagnosed via electrodiagnostic testing and he underwent a medial triceps nerve to axillary nerve transfer. After appropriate postsurgical therapy, the athlete was able to return to American football the subsequent season and continue performing at an elite level. This case report reviews the evaluation and modern treatment for axillary nerve injuries in the athlete, including nerve transfers, nerve grafts, and return to play.
Axillary Nerve Monitoring During Arthroscopic Shoulder Stabilization
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2005
This study evaluated the ability of a novel intraoperative neurophysiologic monitoring method used to locate the axillary nerve, predict relative capsule thickness, and identify impending injury to the axillary nerve during arthroscopic thermal capsulorrhaphy of the shoulder. Type of Study: Prospective cohort study. Methods: Twenty consecutive patients with glenohumeral instability were monitored prospectively during arthroscopic shoulder surgery. Axillary nerve mapping and relative capsule thickness estimates were recorded before the stabilization portion of the procedure. During labral repair and/or thermal capsulorrhaphy, continuous and spontaneous electromyography recorded nerve activity. In addition, trans-spinal motor-evoked potentials of the fourth and fifth cervical roots and brachial plexus electrical stimulation, provided real-time information about nerve integrity. Results: Axillary nerve mapping and relative capsule thickness were recorded in all patients. Continuous axillary nerve monitoring was successfully performed in all patients. Eleven of the 20 patients underwent thermal capsulorrhaphy alone or in combination with arthroscopic labral repair. Nine patients underwent arthroscopic labral repair alone. In 4 of the 11 patients who underwent thermal capsulorrhaphy, excessive spontaneous neurotonic electromyographic activity was noted, thereby altering the pattern of heat application by the surgeon. In 1 of these 4 patients, a small increase in the motor latency was noted after the procedure but no clinical deficit was observed. There were no neuromonitoring or clinical neurologic changes observed in the labral repair group without thermal application. At last follow-up, no patient in either group had any clinical evidence of nerve injury or complications from neurophysiologic monitoring. Conclusions: We successfully evaluated the use of intraoperative nerve monitoring to identify axillary nerve position, capsule thickness, and provide real-time identification of impending nerve injury and function during shoulder thermal capsulorrhaphy. The use of intraoperative nerve monitoring altered the heat application technique in 4 of 11 patients and may have prevented nerve injury. Level of Evidence: Level II, prospective cohort study.
Sport–related peripheral nerve injuries: part 1
Sport Sciences for Health, 2005
Sport–related strenuous physical activity and trauma are among the causes of peripheral nerves injuries, due in most cases to direct blow, compression or repeated traction or friction. Although in most cases the diagnosis is obvious, subtle peripheral nerve injuries can be difficult to recognize and, in most cases, require the support of appropriate instrumental evaluations. This review is divided into
International journal of sports physical therapy, 2014
Case report. A case of an athlete with accessory nerve injury has not been previously reported although there have been a number of case reports and case series of non-athletes with accessory nerve injury. This case study reports motor control intervention for an amateur baseball pitcher with isolated paralysis of the right trapezius who lost pitching control after changing his pitching technique. The subject was able to restore ball control during overhead throwing after physiotherapy. The subject of this case report was a 20-year-old amateur male baseball pitcher, who presented with long-standing isolated paralysis of the right trapezius and a six month history of loss of ball control with shoulder pain during pitching. He was seen for a second opinion following unsuccessful conservative management and underwent physiotherapy to restore his ball control during pitching. Restriction of cervical rotation range of motion and decreased position sense during shoulder abduction and exte...
Suprascapular Neuropathy in a Collegiate Baseball Player
Asian Journal of Sports Medicine, 2012
Background: Suprascapular neuropathy (SSN) is generally thought of as a diagnosis of exclusion. However, increasing attention is being paid to the diagnosis, treatment and rehabilitation of this pathology to prevent chronic supraspinatus and infraspinatus atrophy in patients. To date, literature has only articulated variable or customized treatment and rehabilitation plans without clear standardized care. This case study provides a detailed description of the diagnosis, treatment, and rehabilitation of a collegiate baseball player's recovery from suprascapular nerve release.
A case of dorsal scapular neuropathy in a young amateur boxer
Journal of Rehabilitation Medicine – Clinical Communications, 2018
Neuropathies of the muscles surrounding the shoulder joint are a well-documented cause of pain and weakness in sports people. Repetitive or excessive traction on the nerve supplying the affected muscle is believed to be the primary mechanism. We describe a case of this phenomenon in a young amateur boxer which has never been described in the literature previously. We document our hypothesis on the mechanism of injury as well as a successful treatment strategy we employed. This paper is designed to highlight shoulder pain with associated winging of the scapula should make one wary of a dorsal scapular neuropathy particularly in a sports person who utilises repetitive forceful actions.