Distal peripheral neuropathy after open and arthroscopic shoulder surgery: an under-recognized complication

Distal peripheral neuropathy (DPN) is an under-reported complication after anatomic total shoulder arthroplasty (TSA), reverse shoulder arthroplasty (RSA), and arthroscopic rotator cuff repair (RCR).

We conducted a retrospective review of patients undergoing shoulder arthroplasty or arthroscopic RCR by 4 shoulder surgeons during a 2-year period. The primary outcome measure was the diagnosis of DPN, defined as carpal tunnel syndrome, cubital tunnel syndrome, ulnar tunnel syndrome, and distal radial sensory neuropathy. Patient demographics and clinical course of DPN were recorded. Mean follow-up was 21, 15, and 12 months for TSA, RSA, and RCR, respectively.

Postoperatively, 6 of 85 TSA (7.1%), 7 of 57 RSA (12.3%), and 21 of 753 RCR (2.79%) patients were diagnosed with DPN. The most common neuropathy was cubital tunnel syndrome for TSA and RSA and carpal tunnel syndrome for RCR. The risk of DPN was higher for shoulder arthroplasty (TSA and RSA) compared with the RCR group. After nonsurgical treatment of DPN, complete resolution of symptoms occurred in 33.3% of TSA, 42.86% of RSA, and 71.43% of RCR patients. However, 16.7% of TSA, 14.3% of RSA, and 4.76% of RCR patients with DPN required surgical decompression; 100% of the patients undergoing surgical decompression had complete resolution of symptoms.

DPN is a relatively common complication after shoulder surgery. When it occurs, DPN will often resolve with nonoperative management. Surgical decompression is an effective treatment option in refractory cases.