Axillary Nerve Injury

with Rehab

ExitCare ImageInjury to the axillary nerve may be caused by direct trauma, excessive stretching, shoulder dislocation, or a broken (fracture) bone near the nerve.

SYMPTOMS

  • Losing feeling (numbness) in the upper outer arm, near the deltoid muscle.

  • Shoulder and arm weakness.

  • Arm fatigue.

  • Loss of proper functioning of the shoulder (bringing the arm above shoulder level).

  • Sometimes, there is burning or tingling in the upper arm or shoulder.

  • Shrinking (atrophy) of the deltoid muscle.

CAUSES

Direct trauma to the axillary nerve, too much stretching of the nerve, shoulder dislocation, or a broken bone near the nerve.

RISK INCREASES WITH:

  • Contact sports (football, rugby, hockey, or lacrosse).

  • Poor strength and flexibility.

  • Shoulder surgery complications.

PREVENTION

  • Warm-up and stretch appropriately before activity.

  • Wear properly fitted shoulder pads when needed.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

PROGNOSIS

Axillary nerve injuries usually get better on their own. If the injury is due to direct trauma, the likelihood of it healing on its own is decreased. Surgery is rarely necessary.

RELATED COMPLICATIONS

  • Permanent weakness of the shoulder, particularly when lifting the arm.

  • Persistent pain and numbness in the shoulder.

  • Shoulder stiffness.

  • Not able to compete in athletics.

TREATMENT

Treatment initially involves resting from any activity that causes the symptoms to get worse. Nonsteroidal anti-inflammatory medications may help lessen the pain. It is important to maintain shoulder strength and flexibility, thus strengthening and stretching exercises may be recommended. These exercises may be completed at home or with a therapist. A therapist may recommend additional treatments. If non-surgical (conservative) treatment is unsuccessful, surgery may be required. Surgery involves fixing what is causing the injury. If the cause of injury cannot be determined or fixed, surgery is performed so that you may be able to use another muscle to control the deltoid muscle. Surgery to transfer tendons is needed in people who have problems with activities of daily living. Some athletes are unable to participate in sports if they have an axillary nerve injury, particularly throwing athletes. However, others may be able to compete, such as linemen in football.

MEDICATION

  • If pain medication is needed, your caregiver may recommend over-the-counter medicine.

  • Do not take pain medication within 7 days before surgery.

  • Prescription pain relievers may be given by your caregiver. Use only as directed and only as much as needed.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes, every 2 to 3 hours for inflammation and pain. It should also be applied right after any activity that makes your symptoms worse. Use ice packs or an ice massage.

  • Heat treatment may be used before performing the stretching and strengthening activities prescribed by your caregiver, physical therapist or athletic trainer. Use a heat pack or a warm soak as directed by your caregiver.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 8 weeks even with treatment.

  • New, unexplained symptoms develop.

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Axillary Nerve Injury

These exercises may help you when you start to restore (rehabilitate) your injury to a better condition. Your symptoms may get better with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps to return normal motion to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image ROM - Pendulum

  • Bend at the waist so that your right / left arm falls away from your body. Support yourself with your opposite hand on a solid surface, such as a table or a countertop.

  • Your right / left arm should be perpendicular to the ground. If it is not perpendicular, you need to lean over farther. Relax the muscles in your right / left arm and shoulder as much as possible.

  • Gently sway your hips and trunk so they move your right / left arm without any use of your right / left shoulder muscles.

  • Progress your movements so that your right / left arm moves side-to-side, then forward and backward, and finally, both clockwise and counterclockwise.

  • Complete __________ repetitions in each direction. Many people use this exercise to relieve discomfort in their shoulder as well as to gain range of motion.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Flexion, Seated

  • Sit in a firm chair so that your right / left forearm can rest on a table or a countertop. Your right / left elbow should rest below the height of your shoulder so that your shoulder feels supported and not tense or uncomfortable.

  • Keeping your right / left shoulder relaxed, lean forward at your waist, allowing your right / left hand to slide forward. Bend forward until you feel a moderate stretch in your shoulder, but before you feel an increase in your pain.

  • Hold __________ seconds. Slowly return to your starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Flexion, Standing

  • Stand with good posture. With an underhand grip on your right / left and an overhand grip on the opposite hand, grasp a broomstick or cane so that your hands are a little more than shoulder-width apart.

  • Keeping your right / left elbow straight and shoulder muscles relaxed, push the stick with your opposite hand to raise your right / left arm in front of your body and then overhead. Raise your arm until you feel a stretch in your right / left shoulder, but before you have increased shoulder pain.

  • Avoid shrugging your right / left shoulder as your arm rises by keeping your shoulder blade tucked down and toward your mid-back spine. Hold __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Abduction, Supine

  • Stand with good posture. With an underhand grip on your right / left and an overhand grip on the opposite hand, grasp a broomstick or cane so that your hands are a little more than shoulder-width apart.

  • Keeping your right / left elbow straight and shoulder muscles relaxed, push the stick with your opposite hand to raise your right / left arm out to the side of your body and then overhead. Raise your arm until you feel a stretch in your right / left shoulder, but before you have increased shoulder pain.

  • Avoid shrugging your right / left shoulder as your arm rises by keeping your shoulder blade tucked down and toward your mid-back spine. Hold __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image ROM – Flexion, Active-Assisted

  • Lie on your back. You may bend your knees for comfort.

  • Grasp a broomstick or cane so your hands are about shoulder-width apart. Your right / left hand should grip the end of the stick/cane so that your hand is positioned "thumbs-up," as if you were about to shake hands.

  • Using your healthy arm to lead, raise your right / left arm overhead until you feel a gentle stretch in your shoulder. Hold __________ seconds.

  • Use the stick/cane to assist in returning your right / left arm to its starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Flexion, Standing

  • Stand facing a wall. Walk your right / left fingers up the wall until you feel a moderate stretch in your shoulder. As your hand gets higher, you may need to step closer to the wall or use a door frame to walk through.

  • Avoid shrugging your right / left shoulder as your arm rises by keeping your shoulder blade tucked down and toward your mid-back spine.

  • Hold __________ seconds. Use your other hand, if needed, to ease out of the stretch, and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING EXERCISES - Axillary Nerve Injury

Strength exercises are not often a priority during the early recovery phases of an axillary nerve injury. If your physician, physical therapist, or athletic trainer notes any weakness, he or she will prescribe exercises specific to your current state to supplement your rehabilitation.