en شانه / آرنج Shoulder / Elbow پژوهشی Research Article <div style="text-align: justify;"><strong>Background</strong>: The so-called terrible triad of the shoulder&mdash;defined by the anterior shoulder dislocation, associated with rotator cuff (RC) tear, and axillary nerve injury&mdash;represents a rare but debilitating injury pattern. Due to its multifactorial nature, it poses significant challenges in diagnosis, treatment, and functional recovery.&nbsp;<br> <strong>Objectives</strong>: This study aimed to evaluate clinical and functional outcomes and identify factors influencing recovery in affected patients.<br> <strong>Methods</strong>: This retrospective cohort study included 50 patients diagnosed with the terrible triad of the shoulder between 2011 and 2024. The outcomes included pain severity visual analog scale (VAS), fatigue fatigue severity scale (FSS), and shoulder range of motion (ROM) at 6 and 18 months. Nerve recovery was assessed clinically and via electromyography (EMG). Associations between demographic variables and outcomes were analyzed using appropriate statistical tests.<br> <strong>Results</strong>: The mean age of patients was 54.14&plusmn;8.58 years, and 66% were male. Complete nerve recovery was observed in 36% of patients, partial recovery in 40%, and no recovery in 24%. EMG findings confirmed improvement in 92% of cases. Shoulder ROM improved significantly from 49.98&plusmn;7.96&deg; at 6 months to 62.32&plusmn;11.62&deg; at 18 months (P<0.001). The mean pain score was 3.32&plusmn;1.47, and the mean fatigue score was 67.86&plusmn;11.11. Increasing age was significantly associated with reduced ROM (r=-0.613, P<0.001) and higher pain levels (r=0.434, P=0.002). Male patients demonstrated better ROM at both 6 months (P=0.005) and 18 months (P=0.001), as well as higher rates of complete nerve recovery (P=0.015), but reported greater fatigue (P<0.001). Female patients experienced higher pain levels (P<0.001).<br> <strong>Conclusion</strong>: Older age and female sex are associated with poorer functional outcomes following upper limb nerve injuries. These findings support the presence of a pain&ndash;fatigue&ndash;limited mobility cycle. Early, personalized, and multidisciplinary strategies are essential to optimize recovery outcomes.&nbsp;</div> Terrible triad of the shoulder, Shoulder dislocation, Rotator cuff (RC) tear, Axillary nerve injury, Functional outcome, Range of motion (ROM), Electromyography (EMG) 35 42 http://jros.iums.ac.ir/browse.php?a_code=A-10-2736-4&slc_lang=en&sid=1 Pouria Tabrizian tabrizian.pouria@gmail.com 10031947532846009049 10031947532846009049 No Bone and Joint Reconstruction Research Center, School of Medicine, ShafaYahyaeian Hospital, Iran University of Medical Sciences, Tehran, Iran. Morteza Nakhaei Amroodi drmna@yahoo.com 10031947532846009050 10031947532846009050 No Bone and Joint Reconstruction Research Center, School of Medicine, ShafaYahyaeian Hospital, Iran University of Medical Sciences, Tehran, Iran. Mohammadreza Bahaeddini mrbahaeddini@yahoo.com 10031947532846009051 10031947532846009051 No Bone and Joint Reconstruction Research Center, School of Medicine, ShafaYahyaeian Hospital, Iran University of Medical Sciences, Tehran, Iran. Babak Hashemipour drbabakhashemi@gmail.com 10031947532846009052 10031947532846009052 No Bone and Joint Reconstruction Research Center, School of Medicine, ShafaYahyaeian Hospital, Iran University of Medical Sciences, Tehran, Iran. Fateme Safaei baransafaei16@gmail.com 10031947532846009053 10031947532846009053 No Bone and Joint Reconstruction Research Center, School of Medicine, ShafaYahyaeian Hospital, Iran University of Medical Sciences, Tehran, Iran. Mojtaba Khajeh Alizadeh Attar mojtaba.attar75@gmail.com 10031947532846009054 10031947532846009054 Yes Bone and Joint Reconstruction Research Center, School of Medicine, ShafaYahyaeian Hospital, Iran University of Medical Sciences, Tehran, Iran. Mohammadmehdi Mahdavifar Mahdavifarmohammadmehdi@gmail.com 10031947532846009055 0009-0007-0503-6554 No Bone and Joint Reconstruction Research Center, School of Medicine, ShafaYahyaeian Hospital, Iran University of Medical Sciences, Tehran, Iran.