Abduction of arm6/17/2023 Shoulder depression with contralateral neck flexion Humeral head compresses nerve during extreme abductionĬ5 to C7 merge, travel between clavicle and first rib through axilla to serratus anterior muscle Sensory: skin over lower half of the deltoid Quadrilateral space boundaries: humeral neck, teres major and minor, long head of triceps Initial treatment for many nerve injuries is nonsurgical.įrom brachial plexus, around humeral head, through the quadrilateral space to deltoid/teres minor Recovery is faster if the repetitive activities that exacerbate the injury can be decreased or ceased. Recovery of nerve function is more likely with a mild injury and a shorter duration of compression. When pain or weakness is refractory to conservative therapy, further evaluation (e.g., magnetic resonance imaging, electrodiagnostic testing) or surgical referral should be considered. Plain radiography and magnetic resonance imaging are usually not necessary for initial evaluation of a suspected nerve injury. Specific history features are important, such as the type of activity that aggravates symptoms and the temporal relation of symptoms to activity (e.g., is there pain in the shoulder and neck every time the patient is hammering a nail, or just when hammering nails overhead?). For example, aching lateral elbow pain may be a symptom of lateral epicondylitis or radial tunnel syndrome patients who have shoulder pain and weakness with overhead elevation may have a rotator cuff tear or a suprascapular nerve injury and pain in the forearm that worsens with repetitive pronation activities may be from carpal tunnel syndrome or pronator syndrome. Nerve injury may mimic other common musculoskeletal disorders. The onset of symptoms may be acute or insidious. Nerve injury should be considered when a patient experiences pain, weakness, or paresthesias in the absence of a known bone, soft tissue, or vascular injury. Peripheral nerve injury of the upper extremity commonly occurs in patients who participate in recreational (e.g., sports) and occupational activities.
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