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Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
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Persistent and profound peripheral nerve injuries following reverse total shoulder arthroplasty
Lauren K Dutton1, Jonathan D Barlow1, Michelle F Loosbrock1
1Department of Orthopedic Surgery and Hand Surgery, Mayo Clinic, Rochester, MN, USA.
Journal of Shoulder and Elbow Surgery
|May 2, 2022
Summary
Peripheral nerve injuries after reverse total shoulder arthroplasty (rTSA) are uncommon but can be debilitating. Injuries may result from surgical traction or implant placement, not typically nerve blocks, and often require specialist referral for management.
Area of Science:
- Orthopedic Surgery
- Neurology
- Biomedical Engineering
Background:
- Peripheral nerve injuries (PNI) following reverse total shoulder arthroplasty (rTSA) are infrequently reported.
- These injuries are often misdiagnosed as neuropraxia, especially when perioperative nerve blocks are administered.
- This study investigates PNI patterns and outcomes after rTSA.
Purpose of the Study:
- To evaluate the incidence and patterns of nerve injuries associated with rTSA.
- To assess the outcomes for patients experiencing intraoperative nerve injuries during rTSA.
- To determine the potential role of preoperative nerve blocks in rTSA-related nerve injuries.
Main Methods:
- Retrospective review of patients with major nerve injury post-rTSA referred to a peripheral nerve clinic.
- Collection of demographic data, nerve block history, physical examination findings, and electrodiagnostic studies.
- Analysis of radiographic measurements (acromiohumeral distance, lateral humeral offset) and patient-reported outcomes (QuickDASH).
Main Results:
- Twenty-two patients with postoperative nerve injuries were identified, with an average follow-up of 18.8 months.
- Injury patterns included diffuse pan-plexopathies, frequently involving the posterior and medial cords.
- Most patients received preoperative nerve blocks, but these were not directly attributed as the cause of injury; implant malpositioning was suspected.
- Medial cord injuries correlated with the most severe hand function deficits, with an average QuickDASH score of 53.5.
Conclusions:
- Permanent peripheral nerve injuries, though rare, can occur after rTSA and lead to significant disability.
- Nerve injuries are likely caused by surgical traction or implant malpositioning (distalization/lateralization), not typically preoperative nerve blocks.
- Timely referral to a peripheral nerve specialist is crucial for managing these debilitating injuries, particularly those affecting hand function.
