Complete isolated axillary nerve palsy in college and professional football players: A report of six cases

Axillary nerve injuries are infrequently sustained in football and arc most often a consequence of glenohumeral instability. We present six cases of football players who sustained complete axillary nerve palsies secondary to a direct blow to the lateral aspect of the shoulder from a football helmet. This study is the first to document this injury. The initial presentation, physical examination, treatment, and anatomy are discussed. All lesions were complete, as documented by physical examination and serial EMGs. All patients had an electromyographic/nerve conduction velocity examination 3 weeks following the date of injury and follow-up EMG/NCV at 5 months. Initial electromyographic studies revealed fibrillation potentials with no voluntary motor activity, compatible with a complete axillary nerve injury. All patients were initially treated nonoperatively, emphasizing strengthening of the rotator cuff and electrical stimulation of the deltoid. One patient was treated with exploration of the axillary nerve after a delay in evidence of axillary nerve return. All patients returned to their high level of athletic activity. The time to return to competitive sports was prolonged, averaging 9 months, with maximal recovery occurring at 12 months. The overall follow-up has ranged from 2 to 4 years.