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The axillary nerve originates from the posterior cord and innervates the teres minor and deltoid muscle (Fig 21 7) In addition, the lateral cutaneous nerve of the upper arm arises from the axillary nerve Thus, axillary neuropathies may manifest with weakness of abduction of the upper arm and sensory loss in the region of skin overlying the deltoid muscle Axillary neuropathies may occur in the setting of IBPN, trauma to the shoulder or fractures of the upper humerus, or stretch injury (Table 21 7)8,9,105,122,138,139 Axillary CMAPs may be recorded from the deltoid muscle following supraclavicular stimulation of the brachial plexus to see if there is asymmetrical loss of amplitude on the affected site A super cial radial SNAP would be expected to be normal in an axillary neuropathy and can help distinguish an axillary neuropathy from a posterior cord lesion or upper trunk lesion (Table 21 3) Further, EMG should show evidence of denervation in the deltoid muscle with sparing of radial-innervated muscles in an isolated axillary neuropathy (Table 21 1) In addition, a normal EMG of the supraspinatus, infraspinatus, biceps brachii, pronator teres, and brachioradialis suggests that the lesion is distal to the C5/C6 roots or upper trunk when combined with denervation of the deltoid Axillary neuropathies related to penetrating injuries should be surgically explored Otherwise, these are managed conservatively with pain management and PT/OT If there is no improvement within 6 months, surgical treatment and grafting can be considered140

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vation to upper arm and forearm muscles as well as for cutaneous sensation of large aspects of the arm The clinical and electrodiagnostic features of a radial neuropathy depend on the site of the lesion The super cial radial SNAP should be abnormal, if there is signi cant axonal nerve injury, except with posterior interosseous nerve damage, as this is a purely motor nerve Radial CMAP to the radial-innervated muscles such as the extensor indices proprius should be performed with stimulation below and above the spinal groove to assess for focal conduction block or slowing across this site With signi cant axonal injury the amplitude should be reduced EMG is more helpful in localizing the site and nature of the lesion Evidence of active denervation in the form of brillation potentials and positive sharp waves would be expected in an axonal nerve injury, provided there has been substantial time for Wallerian degeneration to occur In a neuropraxic injury, only reduced recruitment of MUAPs would be appreciated on EMG

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winning message still displays This is because the movie clip is still on frame 2 In addition, if you click the movie clip a third time, nothing happens This is because you never changed gameFinished back to false You will fix both of these problems in the next step

Damage to the nerve in the axilla or proximal upper arm is uncommon but can result from compression (eg, crutches, patients who are intoxicated falling asleep with outstretched arm and upper arm pressed against a hard surface, missile injuries, and other trauma to the axilla) (Table 21 8)8,9,122 Of course, a radial neuropathy can also occur in the setting of a more widespread multifocal process (eg, vasculitis, IBPN) Proximal radial nerve injuries can result in weakness of elbow, wrist, and nger extension as well as supination of the forearm In addition, sensory disturbance may be evident in the posterior aspect of the forearm and back of the hand and ngers Provided there is suf cient axon loss, the super cial radial SNAP and radial CMAP recorded from the extensor indicis proprius may have reduced amplitudes (Table 21 3) EMG should demonstrate signs of

Finally, we return 0 and thus end main():

The radial nerve is one of the major terminations of the posterior cord and is comprised of bers from spinal segments C5 8 and occasionally contains T1 bers (Fig 21 8) The radial nerve is quite long and provides inner-

Trauma Fracture of humerus Improper use of crutches (eg, compression in axilla) Stretch injury (eg, hyperabduction of arm during surgery and sleep) Saturday night palsy (external compression by arm being compressed against rm edge at the spiral groove usually in individuals who are intoxicated) Other external compression (partner falling asleep on arm) Immune-mediated brachial plexus neuropathy Soft-tissue or peripheral nerve tumor Ischemia (eg, A-V stulas and vasculitis) Multifocal motor neuropathy or multifocal acquired demyelinating motor and sensory neuropathy

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