Analysis of Patient-Dependent and Trauma-Dependent Risk Factors for Persistent Brachial Plexus Injury after Shoulder Dislocation

Abstract

Brachial plexus injuries (BPIs) caused by shoulder dislocation usually have a transient character and tend to resolve spontaneously. However, in some patients the symptoms can persist and require operative intervention. This work aims to determine the risk factors for persistent BPIs resulting from shoulder dislocation. The study comprised 73 patients (58 men, 15 women; mean age: 50 years) treated operatively between the years 2000 and 2016 for persistent BPIs resulting from shoulder dislocation. Patient age, gender, type of initial trauma, number of affected nerves, presence of accompanying injuries, and time interval from dislocation to its reduction were analysed. Elderly patients more often sustained multiple-nerve injuries, while single nerve injuries were more often observed in younger patients. Injury to a single nerve was diagnosed in 30% of the patients. Axillary nerve was most commonly affected. Fracture of the greater tuberosity of humerus coincided with total BPI in 50% of the cases. Longer unreduced period caused injury to multiple nerves. Analysis of our patient group against relevant literature revealed that persistent BPI after shoulder dislocation is more common in older patients. Injuries to ulnar and median nerves more often require operative intervention due to low potential for spontaneous recovery of these nerves.

Brachial plexus injury after shoulder dislocation: a literature review

“…In the study by Robinson et al, injury to the axillary nerve alone was more common in young individuals and as a result of high-energy trauma, while complex neurological deficits were associated with older age, female sex and low-energy fall [5]. Another study confirmed that single nerve injury is more likely to be a result of high-energy trauma in a younger patient, while multiple nerve injury would be a result of lowenergy fall in an elderly patient [19]. In the previously cited study by Robinson et al, percentage of multiple nerve lesions was significantly higher in the group with other associated injuries (rotator cuff tear (RCT)/GTF) [5].…”

“…Brachial plexus injury was found in 1.2% of multitrauma patients in the study by Midha et al, with shoulder dislocation being responsible for 7% of closed BPIs [53]. Males predominated in all large patient groups (M/F from 1.3:1 in the study by Robinson et al to 6.3:1 among the patients studied by Fox et al) (Table 1) [5,[18][19][20][21][22].…”

“…In those patients, often being multitrauma victims, multiple other injuries coexist, including fractures of the shoulder girdle, proximal humerus and the first rib, which constitute separate possible causes of injury to the brachial plexus. In the analysed literature, high-energy injury was the cause of shoulder dislocation complicated with BPI in 18-71% of the patients in different studies [5,6,8,9,12,18,19,22,51]. In four studies analysing the largest patient groups, high-energy injury was responsible for 36-43% of the cases [5,18,19,22].…”

“…The mean patient age in this group is higher (usually over 50 years), there are typically no accompanying fractures (fracture of the greater tuberosity of humerus (GTF) can be present) and nerve injury more often has transient character [5,19,22]. Analysis of the literature revealed simple fall to be the most common cause of BPI after shoulder dislocation (18-86% of the patients in different studies), including 43-67% in the four studies on the largest patient groups [5,18,19,22].…”

“…In general, multiple nerve injuries were found more often than injury to a single nerve [7,8,12,16,19,21,22]. In the study by Robinson et al, injury to the axillary nerve alone was more common in young individuals and as a result of high-energy trauma, while complex neurological deficits were associated with older age, female sex and low-energy fall [5].…”