{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T04:34:51Z","timestamp":1777955691254,"version":"3.51.4"},"reference-count":45,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":123,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Brachial Plex Peripher Nerve Inj"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>High-velocity projectile injuries to the regio deltoidea (RD) can result in persistent pain and motor shoulder dysfunction (MSD). The underlying mechanisms may involve direct axillary nerve (Ax) trauma or remote nociceptor irritation caused by cavitation effects.<\/jats:p>\n                  <jats:p>To characterize the anatomical basis of MSD and to establish a reliable diagnostic and surgical strategy for its management.<\/jats:p>\n                  <jats:p>Twenty-seven patients presenting with painful MSD following projectile trauma to the RD were included. Eight patients exhibited deltoid palsy associated with Ax injury, of whom three underwent Ax reconstruction. After positive diagnostic nerve blocks, 25 patients proceeded to denervation of the glenohumeral joint (GHJ): anterior (n\u2009=\u200915) or posterior (n\u2009=\u20093). Surgical procedures included neurotomy of the lateral pectoral nerve (n\u2009=\u200918), suprascapular nerve (n\u2009=\u20093), and Ax (n\u2009=\u20094). In patients with persistent CRPS-like symptoms, neurotomy of the intercostal nerves (ICN) was performed.<\/jats:p>\n                  <jats:p>Pain relief following Ax surgery was achieved in 25%. Anterior GHJ denervation resulted in 60% pain improvement, whereas posterior showed no significant benefit. RD injuries in 45% cases exhibited CRPS type I-like manifestations. Subsequent ICN neurotomy in 12 patients effectively resolved these symptoms.<\/jats:p>\n                  <jats:p>High-velocity projectile injuries to the RD may provoke nociceptor irritation at a distance from the entry site through a cavitation mechanism. Direct Ax injury accounted for only 25% of MSD cases. Irritated nociceptors generate CRPS-like symptoms at painful MSD without overt nerve disruption. Targeted neurotomy of the involved nociceptors represents a reasonable therapeutic option for pain alleviation in selected patients.<\/jats:p>","DOI":"10.1055\/a-2858-9943","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T23:18:19Z","timestamp":1777936699000},"page":"e13-e26","source":"Crossref","is-referenced-by-count":0,"title":["A \u201cCommon Sense\u201d Surgical Approach to Motor Shoulder Dysfunction Diagnosed as CRPS I\/II Following Projectile Injuries to the Regio Deltoidea in the Late Stages of Ballistic Trauma"],"prefix":"10.1055","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2212-2143","authenticated-orcid":false,"given":"Alexander A.","family":"Gatskiy","sequence":"additional","affiliation":[{"name":"Restorative Neurosurgery Department, Romodanov Neurosurgery Institute, Kyiv, Ukraine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ihor B.","family":"Tretyak","sequence":"additional","affiliation":[{"name":"Restorative Neurosurgery Department, Romodanov Neurosurgery Institute, Kyiv, Ukraine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vitaliy I.","family":"Tsymbaliuk","sequence":"additional","affiliation":[{"name":"National Academy of Sciences of Ukraine, Kyiv, Ukraine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iurii L.","family":"Chyrka","sequence":"additional","affiliation":[{"name":"SPINEX Neuro-Orthopedical Clinic, Vinnitsia, Ukraine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergii V.","family":"Vernygorodskyi","sequence":"additional","affiliation":[{"name":"Pathological Anatomy Department, Vinnitsia National Pirogov Memorial Medical University, Vinnitsia, Ukraine"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.rcl.2022.08.005","article-title":"Understanding ballistic injuries","volume":"61","author":"N Ditkofsky","year":"2023","journal-title":"Radiol Clin North Am"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s00068-025-02777-y","article-title":"Principles of wound ballistics and their clinical implications in firearm injuries","volume":"51","author":"P Petrone","year":"2025","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1177\/0846537120902107","article-title":"Imaging ballistic injuries","volume":"71","author":"N G Ditkofsky","year":"2020","journal-title":"Can Assoc Radiol J"},{"key":"ref4","volume-title":"Anatomy, Shoulder and Upper Limb, Deltoid Muscle","author":"A Elzanie","year":"2024"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.2307\/jj.6195014.11","volume-title":"Topographical anatomy of the upper extremity","author":"J Kos","year":"2014"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"405","DOI":"10.5505\/tjtes.2013.08684","article-title":"Management of penetrating injuries of the upper extremities","volume":"19","author":"O J Van Waes","year":"2013","journal-title":"Ulus Travma Acil Cerrahi Derg"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.1038\/s41598-024-51923-w","article-title":"Anatomical considerations for nerve transfer in axillary nerve injury","volume":"14","author":"S J Kim","year":"2024","journal-title":"Sci Rep"},{"issue":"S 01","key":"ref8","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1093\/pm\/pnac046","article-title":"Complex regional pain syndrome: practical diagnostic and treatment guidelines, 5th edition","volume":"23","author":"R N Harden","year":"2022","journal-title":"Pain Med"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/0022-510X(77)90205-2","article-title":"Aids to the examination of the peripheral nervous system","volume":"33","author":"W B Matthews","year":"1977","journal-title":"J Neurol Sci"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"7001350010p1","DOI":"10.5014\/ajot.2016.015487","article-title":"Range of motion requirements for upper-limb activities of daily living","volume":"70","author":"D H Gates","year":"2016","journal-title":"Am J Occup Ther"},{"issue":"03","key":"ref11","first-page":"468","article-title":"Proper performance and interpretation of electrodiagnostic studies. 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