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Orthopaedics
Axillary Nerve Lesion with Deltoid Paralysis
Built from Pillemer — Physical Signs in Orthopaedics and Neurology
What’s inside
6 sections · 40 slides
Overview
- What this topic is really asking
- Roadmap for this topic
The Clinical Puzzle
Near-normal shoulders with a dead deltoid
- The question at the heart of this topic
- A striking case report
- The soldier's shoulder was doing heavy work
- What the examination and scans showed
- Deltoid wasting with a prominent greater tuberosity
- What the authors could and could not explain
- The literature review, in numbers
- How good was the recovery in the permanent cases
- What the standard textbook says
- The gap the textbook leaves open
- The puzzle in three cards
Anatomy of the Axillary Nerve
Where the wire runs, and why it tears
- Tracing the axillary nerve from its source
- The axillary nerve and the quadrilateral space
- The quadrilateral space, boundary by boundary
- What the axillary nerve controls
How Abduction Normally Works
The deltoid and supraspinatus as a team
- Two muscles, one lift
- Force directed into the socket during abduction
- Who does what during a normal lift
- Why this pairing matters for the puzzle
The Explanation
The long head of biceps takes over
- Restating the question, then the answer
- A clue from the operating theatre
- The idea behind the three-step test
- Three-step test for biceps compensation
- The three-step test, step by step
- Reading the result
- The three steps at a glance
- What this means and one practical caution
Summary and Takeaways
- From injury to preserved function
- Key takeaways
- A patient with a complete axillary nerve lesion still abducts well. Explain it, and how would you test the idea?
- References
- Physical Signs in Orthopedic and Neurologic Disorders: A Practical Guide