Brachial Plexus Injuries Associated With Open Subpectoral Biceps Tenodesis: A Report of Two Cases

Area of Science:

• Orthopedic surgery
• Neurosurgery
• Musculoskeletal disorders

Background:

• Open subpectoral biceps tenodesis is a common procedure for managing biceps tendon pathology.
• Nerve injury, particularly to the brachial plexus, is a potential complication, though rarely reported.

Observation:

• Two cases of brachial plexus injury following open subpectoral biceps tenodesis are presented.
• One injury was attributed to nerve stretch from retractor placement.
• The second injury involved severed nerves, hypothesized to be caused by a drill bit during fixation.

Findings:

• The cases highlight the risk of both stretch and direct transection injuries to the brachial plexus.
• Retractor use and the drilling/fixation process are critical points for potential nerve damage.

Implications:

• Recommendations include meticulous retractor management to avoid traction injuries.
• Utilizing a protective sleeve during drilling and tenodesis screw fixation is advised to prevent inadvertent nerve wrapping or transection.
• These preventative measures aim to reduce the incidence of brachial plexus injuries in this surgical procedure.