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Updated: Mar 14, 2026

Reverse Total Shoulder Arthroplasty
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Nerve stress during reverse total shoulder arthroplasty: a cadaveric study.

Hubert Lenoir1, Louis Dagneaux2, François Canovas3

  • 1Centre Ostéo-Articulaire des Cèdres, Echirolles, France.

Journal of Shoulder and Elbow Surgery
|October 5, 2016
PubMed
Summary

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Surgeons should limit shoulder extension during humeral preparation and be cautious during glenoid exposure in reverse total shoulder arthroplasty (RTSA). Avoiding extreme rotation and oversized implants minimizes nerve stress and potential neuropathies.

Area of Science:

  • Orthopedic Surgery
  • Biomechanical Engineering
  • Neuroscience

Background:

  • Neurologic lesions are a known complication following total shoulder arthroplasty.
  • Traction injury is the primary cause of these neurologic lesions.
  • Identifying surgical factors contributing to nerve stress during reverse total shoulder arthroplasty (RTSA) is crucial.

Purpose of the Study:

  • To determine specific arm manipulations and surgical steps during RTSA that increase stress on nerves.
  • To provide data to help surgeons minimize iatrogenic nerve injury during RTSA.

Main Methods:

  • Nerve stress was quantified using a tensiometer on brachial plexus nerves in 10 cadaveric shoulders.
  • Measurements were taken during various arm positions and surgical steps of RTSA.
Keywords:
Nerve stressbrachial plexus injurycadaveric studyneurologic complicationsreverse total shoulder arthroplastyshoulder position

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  • The influence of implant size (polyethylene humeral cup thickness) on nerve stress was also assessed.

    • Main Results:

    • Internal rotation increased radial and axillary nerve stress; external rotation increased musculocutaneous, median, and ulnar nerve stress.
    • Shoulder extension significantly increased stress on all measured nerves.
    • Humeral and glenoid exposition were identified as high-risk steps, with extension exacerbating stress.
    • Thicker polyethylene humeral cups correlated with increased nerve stress for most nerves.

    Conclusions:

    • Limiting shoulder extension during humeral preparation is essential.
    • Careful technique is required during glenoid exposure to prevent nerve injury.
    • Avoiding extreme rotational positions and oversized implants can reduce the risk of stretch-induced neuropathies in RTSA.