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Evaluation-Physical Examination

The physical examination of athletes with axillary nerve injury should include evaluation for range of motion (passive and active) as well as strength (abduction, forward elevation, external rotation, and internal rotation). Patients with a chronic history of the problem may demonstrate atrophy or asymmetry of the deltoid muscle mass.

A neurovascular examination should be performed to assess sensation over the upper lateral arm and to rule out other lesions, such as TOS, and brachial plexus and cervical spine lesions. It is important to note that complete deltoid muscle deficit may occur with normal sensation of the upper lateral arm and shoulder.

Identification of the quadrilateral space syndrome is difficult, because many signs are nonspecific. Some patients may have tenderness of the posterior shoulder in the area of the quadrilateral space. Symptoms are most likely to be reproduced with the FABER (forward elevation, abduction, and external rotation) test of the shoulder, which is held for more than 1 minute.

Wasting or atrophy of the deltoid and/or teres minor muscles may be noted when evaluating the patient with the shirt off. Resisted muscle strength testing of the shoulder should be performed with the shoulder in abduction, forward flexion, and extension to assess deltoid muscle strength. External rotation strength also should be tested to assess the teres minor, although the patient may not appear to have weakness because of the function of the infraspinatus muscle. Pulses in the upper extremities should be normal.

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