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Neurological Rehabilitation

Concurrent Axillary and Suprascapular Mononeuropathies Following an Anterior Shoulder Dislocation: A Case Report

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 5

    Poster Presenter(s)

  • Autumn Dach, DO

    Resident Physician
    Mayo Clinic College of Medicine & Science (Rochester) PM&R Program
    Rochester, Minnesota

    • Co-Author(s)

  • DL

    Devin Leland, MD

    Orthopedic Surgery Resident
    Mayo Clinic
    Rochester, Minnesota

  • JB

    Jonathan Barlow, MD

    Orthopedic Surgeon
    Mayo Clinic
    Rochester, Minnesota

  • James B. Meiling, DO

    Assistant Professor of PM&R and Neurology
    Mayo Clinic - PM&R Dept.
    Rochester, Minnesota

Disclosure(s):
Autumn Dach, DO: No financial relationships to disclose
James B. Meiling, DO: No financial relationships to disclose
Case Diagnosis: Axillary and suprascapular mononeuropathies following anterior shoulder dislocation.

Case Description or Program Description: 74-year-old female with a history of breast cancer and post-treatment chronic right arm lymphedema dislocated her right shoulder after a fall and underwent reduction within 12 hours. She had persistent shoulder weakness limiting her work and daily activity performance. Neurologic examination showed right arm patchy sensory loss, reduced active range of motion, and significant weakness with shoulder abduction and external rotation.

Setting: Tertiary Academic Medical Center

Assessment/Results: Right shoulder MRI revealed a massive full-thickness tear with supraspinatus and infraspinatus tendon retraction. Routine nerve conduction studies (NCS) were normal; however, axillary motor NCS were asymmetric (right 0.6 mV; left 3.4 mV). Needle electromyography (EMG) showed active denervation and severely reduced recruitment of large motor unit potentials (MUPs) within all 3 deltoid heads and mildly in the supraspinatus and infraspinatus. Ultrasound-(US)-guidance was used for needle placement into the teres minor, which was normal. She had a severe, chronic, active right axillary mononeuropathy, sparing the teres minor, and a mild, chronic, active right suprascapular mononeuropathy.

Discussion (relevance): Shoulder dislocations are associated with nerve injuries in 65%, most commonly as brachial plexopathies and axillary mononeuropathies. EMG should assess all 3 deltoid heads and teres minor as each is innervated by different branches. US-guidance can ensure accurate needle placement into teres minor rather than infraspinatus, as they are innervated by different peripheral nerves despite sharing the same action. Rarely, massive rotator cuff tears may cause medial muscular traction and subsequent stretch injury to the suprascapular nerve.

Conclusions: This case emphasizes the importance of a broad differential for shoulder weakness post-dislocation and consideration of the presence of concurrent peripheral nerve injuries. Accurate diagnosis allows targeted management, guiding rehabilitation, and potential surgical interventions.