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.

To characterize the anatomical basis of MSD and to establish a reliable diagnostic and surgical strategy for its management.

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 = 15) or posterior (n = 3). Surgical procedures included neurotomy of the lateral pectoral nerve (n = 18), suprascapular nerve (n = 3), and Ax (n = 4). In patients with persistent CRPS-like symptoms, neurotomy of the intercostal nerves (ICN) was performed.

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.

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.

All authors made a substantial contribution to the acquisition, analysis, and interpretation of data, drafted the article, and critically revised it for important intellectual content.

Romodanov Neurosurgery Institute does not require ethical approval for reporting individual case series.

Written informed consent was obtained from all patients for the publication of their anonymized data in this article.

aNeurotomy performed during joint denervation surgery presumed immediate reconstruction of the neurotomized mixed sensorimotor nerve via direct suture or nerve transfer in order to avoid long-term iatrogenic motor dysfunction of the shoulder.

Received: 10 November 2025

Accepted after revision: 19 April 2026

Article published online:
04 May 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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