Neurologic deficit after reverse total shoulder arthroplasty: correlation with distalization.

Area of Science:

• Orthopedic Surgery
• Neurology
• Biomedical Engineering

Background:

• Neurologic complications following reverse total shoulder arthroplasty (RTSA) are documented but lack detailed analysis of specific nerve involvement and patient outcomes.
• Limited research exists on the prevalence and characteristics of neurologic deficits post-RTSA.

Purpose of the Study:

• To determine the incidence and outcomes of neurologic deficits after RTSA.
• To investigate the association between non-anatomical shoulder joint reconstruction and neurologic complications.
• To test the hypothesis that excessive humeral distalization or lateralization correlates with neurologic deficits.

Main Methods:

• A cohort of 182 consecutive shoulders undergoing RTSA for cuff tear arthropathy was analyzed.
• Comparative analysis was conducted between 34 shoulders with neurologic deficit (Group 1) and 148 without (Group 2).

Main Results:

• Neurologic deficit was observed in 19% of patients (34 shoulders) at a mean follow-up of 58.5 months.
• Group 1 showed significantly greater postoperative acromiohumeral distance (34.1 mm vs 29.4 mm) and humeral distalization (24.5 mm vs 20.5 mm) compared to Group 2.
• Axillary nerve injuries (41.2%) were most common, followed by radial nerve injuries (15%). Most deficits were neuropraxia (88%).

Conclusions:

• Neurologic deficit after RTSA affects 19% of patients and is significantly linked to postoperative humeral distalization.
• The axillary nerve is the most frequently affected nerve.
• All patients with neurologic complications experienced complete recovery through conservative management, with a mean recovery time of 7.4 months, without requiring further surgery.