1609 - Out of the Storm and Into Rehab: Pediatric Axillary Nerve Injury from Hurricane-Related Blunt Trauma

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

LA

Lucendia Adams, MD

Resident Physician
Indiana University School of Medicine
Indianapolis, Indiana, United States

Submitter(s)

LA

Lucendia Adams, MD

Resident Physician
Indiana University School of Medicine
Indianapolis, Indiana, United States

Case Diagnosis: Axillary Neurapraxia

Case Description: 17 yo female presented to the Pediatric Brachial Plexus Injury Clinic with four months of right upper extremity pain, paresthesia, and weakness after a tree fell on her shoulder during Hurricane Helene. MRI of the right shoulder revealed a small posterior labral tear, but no findings to explain her paresthesia and weakness. She was noted to have right deltoid atrophy with weakness in shoulder abduction and humeral extension with reduced sensation and allodynia over the right lateral shoulder. Nerve conduction studies revealed normal sensory and motor conductions of the right median and ulnar nerves as well as a normal right lateral antebrachial cutaneous sensory study. The EMG study was notable for increased fibrillation potentials and positive sharp waves at rest along with small polyphasic motor unit action potentials with decreased recruitment. She was diagnosed with an isolated subacute right axillary nerve injury with active reinnervation.

Discussions: The top causes of axillary nerve injury include anterior shoulder dislocation, proximal humeral fracture, and blunt trauma. Any of these etiologies can compress the quadrangular space which contains the axillary nerve after it branches from the posterior cord of the brachial plexus. In this patient’s case, the blunt force from a falling tree branch cause an isolated axillary nerve injury resulting in the deltoid atrophy, sensory changes over the lateral arm, and weakness. Her EMG confirmed the diagnosis with a notably normal lateral antebrachial cutaneous sensory study signifying no upper brachial plexus injury, and needle exam with evidence of active denervation as well as reinnervation at the right deltoid. She completed 2 months of outpatient occupational therapy with improvement in her strength and made a full functional recovery.

Conclusions: Axillary mononeuropathies represent just 0.3%–6% of brachial plexopathies. This case emphasizes the importance of electrodiagnostics in confirming diagnosis and directing rehabilitation