gms | German Medical Science

Objective: Traumatic or iatrogenic nerve lesions have a deep impact on patient’s activities. Depending on the involved nerve movement and joint stability as well as chains of movement in the three-dimensional space are impaired. Recovery crucially depends on depth of lesion. In addition, different nerves display different regeneration capacity. Radial nerve is considered to have a good prognosis for spontaneous recovery In contrast, axillary nerve lesions have a bad reputation. We therefore present our patient collective with isolated axillary and radial nerve lesions, decision making, pre- and intraoperative assessment, choice of strategy and the clinical outcome.

Methods: We retrospectively analyzed our collective of over n= 170 patients (2012-2016) with traumatic nerve lesions. N=23 showed an isolated axillary and n=37 an isolated radial nerve affection. Pre- and postoperative assessment included clinical features, electrophysiology, MRI and ultrasound. Intraoperatively, a microsurgical setting was used, enhanced by intraoperative electrophysiology and ultrasound. The individual lesion influenced on surgical techniques and approaches applied.

Results: For axillary nerve n= 13/24 patients were grafted (n=3 infraclavicular only, n=9 from infraclavicular to dorsal, n=1 dorsal only). In n=11 decompression and external/ internal microsurgical neurolysis was performed. N= 1 patient required direct muscular neurotisation. N= 1 patient with a long interval from trauma to nerve surgery and significant shoulder joint lesion received a free muscle transfer. In n=13/ 15 patients with a follow-up >9 months a MRC ≥ 3 for deltoid muscle could be achieved. For radial nerve n=19 required autologous transplantation, n=2 could be coaptated end-to-end. In n=8 patients an extraneural decompression only sufficed, n=8 needed epineuriotomy with n=1 bearing an intraneural hematoma. In n=18/20 patients with a minimum follow-up of 9 months MRC ≥ 3 could be achieved for wrist and finger extension. No persistent new neurological deficit was observed, no complication occurred.

Conclusion: In our series, results after treatment of axillary nerve lesions are promising and better than its reputation. In contrast, most radial nerve patients showed significant lesions with no chance for spontaneous recovery We could prove the feasibility of pluriportal access. Results seem to depend on joint function. Timing is of essence, therefore meticulous preoperative evaluation including all modalities is mandatory the assess the depth of nerve lesion and thus choose the appropriate treatment.