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10:10
Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
43.9K
Intraoperative neuromonitoring during reverse shoulder arthroplasty
Satoshi Shinagawa1, Hitoshi Shitara1, Atsushi Yamamoto2
1Department of Orthopedics, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Journal of Shoulder and Elbow Surgery
|May 9, 2019
Summary
Neuromonitoring during reverse total shoulder arthroplasty identified nerve injury risks, particularly to the axillary nerve during glenoid and humeral implantation. This highlights the importance of vigilant monitoring for patient safety.
Area of Science:
- Orthopedic Surgery
- Neurophysiology
- Surgical Safety
Background:
- Reverse total shoulder arthroplasty (RTSA) is a common procedure for complex shoulder conditions.
- Potential nerve injury is a significant concern during RTSA.
Purpose of the Study:
- To assess the risk of nerve injury using intraoperative neuromonitoring during RTSA.
- To identify specific nerves and surgical stages associated with increased risk.
Main Methods:
- 15 patients undergoing RTSA were monitored using somatosensory evoked potentials (SSEPs), transcranial motor evoked potentials (TMEPs), and free-electromyography (fEMG).
- Nerve alerts were defined by specific amplitude or latency changes and neurotonic discharge.
- Data was collected on alerts related to specific nerves and surgical phases (glenoid/humeral implantation).
Main Results:
- 31 nerve alerts were recorded in 11 out of 15 patients.
- The axillary nerve was the most frequently affected, with 17 alerts.
- Alerts predominantly occurred during glenoid (11) and humeral (5) implantation procedures.
Conclusions:
- The axillary nerve is at the highest risk of injury during RTSA.
- Glenoid and humeral implantation phases pose the greatest risk for nerve alerts.
- Intraoperative neuromonitoring is crucial for detecting and potentially preventing nerve injuries in RTSA.
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