Not everything is as it seems

Area of Science:

• Anesthesiology
• Neurology
• Orthopedic Surgery

Background:

• Shoulder rotator cuff injuries are commonly treated surgically.
• Interscalene brachial plexus blocks and general anesthesia are frequently used for shoulder surgery pain management.
• Perioperative neurological deficits require careful differential diagnosis.

Observation:

• A patient undergoing shoulder surgery developed neurological deficit in the nonoperative upper limb post-anesthesia.
• The deficit's location on the nonoperative side immediately suggested it was unrelated to the nerve block or surgical procedure.
• Prompt recognition of the deficit's origin was crucial for accurate diagnosis.

Findings:

• Neurological deficit in the nonoperative limb following surgery for rotator cuff injury under interscalene brachial plexus block and general anesthesia.
• The case demonstrates that neurological symptoms in the perioperative period may have causes unrelated to the anesthetic technique or surgical intervention.
• Attributing perioperative neurological symptoms solely to nerve blocks or surgical complications can delay diagnosis.

Implications:

• Emphasizes the need for a broad differential diagnosis for perioperative neurological deficits.
• Highlights the importance of thorough neurological assessment in the immediate postoperative period.
• Suggests that anesthesiologists and surgeons should maintain a high index of suspicion for non-iatrogenic causes of neurological symptoms.