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Management-Nonoperative Management

Nonoperative management of an axillary nerve injury includes reassurance, activity modification, symptomatic management, and physical therapy. As the nerve recovers, active, passive-, and active-assisted range of shoulder motion should be performed to maintain motion, and electrical stimulation and strengthening exercises may help to reduce atrophy of the deltoid.

The athlete should be reassured of nerve recovery, because the prognosis after shoulder fracture, dislocation, or direct trauma generally is good. Full recovery of axillary nerve injury caused by dislocation or fracture is expected in 85% to 100% of cases managed conservatively within 6 to 12 months from the time of injury. Even if the deltoid paralysis persists, return to sports like football and rugby is possible—and quite likely.

Specifically, nonoperative treatment of quadrilateral space syndrome, which should be tried initially, should include aggressive stretching of the posterior shoulder, especially the teres minor, as well as assessment of biomechanics during sports, such as a patient’s throwing, serving, or hitting, which should be corrected if possible.

Most cases of quadrilateral space syndrome are thought to be self-limiting, and symptoms resolve with nonoperative treatment. Athletes should avoid lifting heavy objects or participating in activities that exacerbate symptoms (usually overhead movements) until symptoms improve.

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