How Axillary Neuropathy Impacts Shoulder Function And How To Treat It

Axillary neuropathy, often referred to as damage to the axillary nerve, affects shoulder function by interfering with muscle strength, movement, and sensation. The axillary nerve is a continuation of the posterior cord of the brachial plexus and is responsible for innervating key shoulder muscles, including the deltoid and teres minor. This condition can result from traumatic injuries, such as a shoulder dislocation, or from repetitive strain, especially in athletes who perform overhead motions, like throwers and swimmers.

What Causes Axillary Neuropathy?

There are several causes of axillary neuropathy:

Trauma: Blunt trauma, particularly from sports such as football, rugby, and weightlifting, can damage the axillary nerve. This often occurs due to a fall or an impact to the shoulder area.
Shoulder Dislocations: One of the most common causes of axillary nerve injury is shoulder dislocation. The nerve can be stretched or compressed during the dislocation process, leading to damage. Studies show that between 9 and 18% of people with shoulder dislocations experience axillary nerve damage.
Quadrangular Space Syndrome (QSS): This is a more chronic form of axillary neuropathy and occurs when the nerve is compressed within the quadrangular space of the shoulder. Factors such as hypertrophy of shoulder muscles, carrying heavy backpacks, or repetitive overhead activity can contribute to QSS. Overhead athletes, such as throwers or swimmers, are particularly at risk due to the constant strain on the shoulder.

Clinical Symptoms of Axillary Neuropathy

The clinical presentation of axillary neuropathy often includes:

Pain and Discomfort: Patients typically experience a dull, poorly localized aching in the shoulder. The pain might not be intense but can become more noticeable at night.
Numbness and Paresthesia: Sensory symptoms may include numbness or tingling sensations, particularly around the deltoid region. These symptoms are often worse during the night.
Shoulder Weakness: The most prominent issue is often weakness in the shoulder, specifically in the deltoid muscle, which leads to difficulty lifting the arm or performing overhead activities. Overhead athletes may experience rapid fatigue with overhead lifting or activities that require external rotation of the shoulder.
Exacerbation with Activity: Symptoms tend to worsen with activities involving arm abduction (lifting the arm away from the body) and external rotation, particularly in the late cocking phase of throwing.

How to Treat Axillary Neuropathy

Conservative management is typically effective for most patients with axillary neuropathy. Treatment options include:

Rest and Activity Modification: Overhead athletes and those involved in repetitive overhead motions may benefit from reducing or modifying their activity. Altering throwing mechanics can significantly help in up to 90% of patients.
Stretching and Strengthening: Range-of-motion exercises should be incorporated to prevent joint contracture, and strengthening exercises for the deltoid and rotator cuff muscles are important to restore muscle function.
Massage and Myofascial Release: Cross-friction massage or myofascial release to the muscles of the quadrangular space may help alleviate muscle tightness and improve mobility.
Electrical Stimulation: Techniques like Russian stim can be useful to prevent deltoid muscle wasting and improve function.
Non-Surgical Treatments: NSAIDs or anti-inflammatory modalities can be beneficial in reducing inflammation and alleviating pain.
Surgical Intervention: If conservative treatments fail after three to six months, surgery may be considered. Surgical options include neurolysis (release of fibrous bands) and, in severe cases, nerve grafting. Surgical outcomes are generally positive, with most patients showing significant recovery.

Seeking Help for Axillary Neuropathy

Axillary neuropathy can significantly affect shoulder function, especially for athletes and those engaged in overhead movements. If you’re experiencing symptoms like shoulder weakness, numbness, or pain, it’s important to seek treatment as early as possible. At Cole Pain Therapy Group, our team is experienced in diagnosing and managing axillary nerve injuries. We can work with you to develop a personalized treatment plan aimed at restoring function and preventing further damage. Don’t hesitate to reach out and schedule a consultation to get on the path to recovery.

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Richard L. Cole, DC, DACNB, DAIPM, FIACN, FICC
Jeffrey D. Luebbe, DC, CCRD, CCSP
W. Steven Vollmer, DC, DAAPM
Bradford J. Cole, DC, MS, CSCS
J. Colby Poston, DC
Daniel H. Smith, DC
2845 Summer Oaks Dr., Memphis, TN 38134
(901) 377-2340

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