Brachial plexus deficits in patients undergoing shoulder arthroplasty

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Patient Outcomes

Background:

• Nerve deficits after shoulder arthroplasty contribute to significant patient morbidity.
• Understanding the incidence and patterns of nerve injury is crucial for improving surgical outcomes.

Purpose of the Study:

• To determine the incidence and pattern of nerve injury following shoulder arthroplasty.
• To evaluate nerve recovery and identify potential preventative measures for nerve injuries during shoulder replacement procedures.

Main Methods:

• A retrospective review of shoulder arthroplasties performed between September 2014 and August 2019 was conducted.
• Data were extracted from patient records, excluding cases with pre-existing nerve injuries.

Main Results:

• A total of 220 shoulder arthroplasties were performed, with an overall nerve deficit rate of 2.3% (5/220).
• All five nerve deficits occurred after reverse total shoulder arthroplasty (rTSA); two resolved within 12 months, and two were persistent.
• Incomplete follow-up was noted for one patient with a nerve deficit.

Conclusions:

• Nerve injury rates in this series of rTSA are low and align with existing systematic review data.
• Preventative strategies for rTSA include meticulous soft tissue handling, precise arm positioning, and avoiding excessive lowering of the rotation center.
• Postoperative nerve deficits necessitate specialist neurosurgical consultation and established referral pathways for timely management.