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[Simultaneous lesions of the rotator cuff and the brachial plexus]
1Dpt de Traumatologie, Hôpital Clinique n. 11, Novosibirsk, Russie.
Introduction:
A simultaneous lesion of the rotator cuff can be associated with a lesion of the brachial plexus and should be considered when treating the lesion of the brachial plexus. The author assesses the value of isolated rotator cuff repair.
Material And Methods:
22 patients presented a rotator cuff tear associated with axillary nerve palsy. All of these lesions were traumatic in origin and in 20 cases were secondary to anterior shoulder dislocation. The clinical presentation was that of a "floating shoulder" with a reduction of the scapulo-humeral angle when attempting to elevate the arm. This differed from a pseudo-paralytic shoulder due to massive rotator cuff tear in which the scapulo-humeral angle remains open and from isolated paralysis of the deltoid in which active elevation of the arm is possible due to the intact rotator cuff. All of the patients had surgical repair of the rotator tear without any procedures on the deltoid. The delay from accident to surgery was on the average 65 days (range: 7 days to 9.5 months). 22 cases were followed for an average of 25 months (range: 12 to 45 months).
Results:
20 of the 22 cases recovered an active elevation of the arm of 120 degrees despite persistent deltoid paralysis in four cases.
Discussion:
Our results show that the rotator cuff, especially the supraspinatus constitutes the main "motor" for shoulder elevation.