La mononeuropathie axillaire constrictive — une nouvelle entité clinique

IF 0.9 4区医学 Q4 ORTHOPEDICS

Hand Surgery & Rehabilitation Pub Date : 2024-12-01 DOI:10.1016/j.hansur.2024.101866

Crina-Victoria Onciu , Bénédicte Chevrier , Frederic Teboul

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引用次数: 0

Abstract

Constrictive axillary nerve neuropathy is an idiopathic disease, which is underestimated by most of the clinicians. In most of the patients, it leads to permanent motor deficits in the shoulder area. Hourglass like constriction and torsion of the axillary nerve is evocated as the cause of symptoms, unrelated to intrinsic or extrinsic compression.

In this retrospective study, pre-, intra- and postoperative findings of 10 patients with constrictions/torsions of axillary nerve were analyzed. The patients underwent surgery in our nerve surgery center over a period of 10 years (Jan. 2014–April 2024). Surgical exploration revealed hourglass shaped constriction of the axillary nerve in all cases, without motor response in all three parts of the deltoid muscle in 7 cases, and severe involvement of the anterior and lateral deltoid muscle with sparing of posterior deltoid muscle in 3 cases. Depending on the intraoperative findings, end-to-end sutures (n = 2), nerve grafting (n = 1) and nerve transfers (n = 7) were performed.

At the follow-up, the patients were re-examined. All of them reported subjective improvement in motor deficits. Clinically and electromyographically, a reinnervation and significant increase in strength from a pre-existing strength grade of M0 to M4+ were described in the cases where nerve transfers were performed. The patient that had nerve grafting as surgical treatment recorded the least improvement (M3).

Constrictive axillary mononeuropathy must not be confused with Parsonage-Turner syndrome. The reason for the vulnerability of the axillary nerve has not been yet elucidated. This disease seems to affect more young and athletic males. Previous studies suggest that surgical exploration must be performed to exclude a compression lesion in the quadrilateral space. During surgical exploration, we have not noticed any nervous site compression, but signs of nervous inflammation were present. Considering the results, surgical treatment via neurotization with a radial nerve branch remains the best choice of treatment.

In case of constrictive axillary mononeuropathy, surgical treatment is recommended as soon as possible. However, diagnosis is often difficult and can be masked by compensatory mechanisms of the adjacent shoulder muscles. Very good results can usually be achieved with nervous transfer usually from branches of the radial nerve.

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来源期刊

Hand Surgery & Rehabilitation Medicine-Surgery

CiteScore

1.70

自引率

27.30%

发文量

审稿时长

49 days

期刊介绍： As the official publication of the French, Belgian and Swiss Societies for Surgery of the Hand, as well as of the French Society of Rehabilitation of the Hand & Upper Limb, ''Hand Surgery and Rehabilitation'' - formerly named "Chirurgie de la Main" - publishes original articles, literature reviews, technical notes, and clinical cases. It is indexed in the main international databases (including Medline). Initially a platform for French-speaking hand surgeons, the journal will now publish its articles in English to disseminate its author''s scientific findings more widely. The journal also includes a biannual supplement in French, the monograph of the French Society for Surgery of the Hand, where comprehensive reviews in the fields of hand, peripheral nerve and upper limb surgery are presented. Organe officiel de la Société française de chirurgie de la main, de la Société française de Rééducation de la main (SFRM-GEMMSOR), de la Société suisse de chirurgie de la main et du Belgian Hand Group, indexée dans les grandes bases de données internationales (Medline, Embase, Pascal, Scopus), Hand Surgery and Rehabilitation - anciennement titrée Chirurgie de la main - publie des articles originaux, des revues de la littérature, des notes techniques, des cas clinique. Initialement plateforme d''expression francophone de la spécialité, la revue s''oriente désormais vers l''anglais pour devenir une référence scientifique et de formation de la spécialité en France et en Europe. Avec 6 publications en anglais par an, la revue comprend également un supplément biannuel, la monographie du GEM, où sont présentées en français, des mises au point complètes dans les domaines de la chirurgie de la main, des nerfs périphériques et du membre supérieur.