Prevalence, management, and outcomes of nerve injury after shoulder arthroplasty: a case-control study and review of the literature

Neurologic injury is a rare and potentially devastating complication of shoulder arthroplasty. Patients typically present with a mixed plexopathy or mononeuropathy, most commonly affecting the axillary and radial nerves. Given the paucity of studies available on the topic, our goal was to elucidate...

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Bibliographic Details
Published in:JSES reviews, reports, and techniques reports, and techniques, 2022-11, Vol.2 (4), p.458-463
Main Authors: Olson, Jeffrey J., O’Donnell, Evan A., Dang, Khang, Huynh, Tiffany M., Lu, Amy Z., Kim, Christine, Haberli, Jillian, Warner, Jon J.P.
Format: Article
Language:English
Subjects:
Nerve injury
Nerve recovery
Neurapraxia
Reverse shoulder arthroplasty
Review and Full-Length
Total shoulder arthroplasty
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Summary:Neurologic injury is a rare and potentially devastating complication of shoulder arthroplasty. Patients typically present with a mixed plexopathy or mononeuropathy, most commonly affecting the axillary and radial nerves. Given the paucity of studies available on the topic, our goal was to elucidate the prevalence of nerve injury after shoulder arthroplasty and to describe the treatment course and outcomes of neurologic injuries. This is a retrospective case-control study performed at a single, urban, academic institution. Consecutive patients who underwent anatomic total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA) by a single surgeon from 2014 to 2020 were reviewed, and patients with a documented nerve injury were identified. A control group of patients without nerve injury were selected in a 2:1 ratio controlling for age and procedure type (TSA vs. RSA; primary vs. revision). Data collected included demographics, comorbidities as per the Charlson Comorbidity Index, radiographic evaluations, surgical and implant details, patient-reported outcome measures, and perioperative complications. Of 923 patients, 33 (3.6%) sustained an iatrogenic nerve injury: 10 (2.1%) after TSA, 23 (5.0%) after RSA, and 3 (7.8%) after revision arthroplasty. Axillary mononeuropathy was most common (42%), followed by brachial plexopathies (18%). There was no significant difference in age, sex, race, body mass index, and preoperative diagnoses between groups. Patients with nerve injury had fewer comorbidities (Charlson Comorbidity Index
ISSN:2666-6391
2666-6391
DOI:10.1016/j.xrrt.2022.04.009