Brachial plexus injury after shoulder dislocation: a literature review

Abstract

Brachial plexus injuries are among the rarest but at the same time the most severe complications of shoulder dislocation. The symptoms range from transient weakening or tingling sensation of the upper limb to total permanent paralysis of the limb associated with chronic pain and disability. Conflicting opinions exist as to whether these injuries should be treated operatively and if so when surgery should be performed. In this review, available literature dedicated to neurological complications of shoulder dislocation has been analysed and management algorithm has been proposed. Neurological complications were found in 5.4-55% of all dislocations, with the two most commonly affected patient groups being elderly women sustaining dislocation as a result of a simple fall and young men after high-energy injuries, often multitrauma victims. Infraclavicular part of the brachial plexus was most often affected. Neurapraxia or axonotmesis predominated, and complete nerve disruption was observed in less than 3% of the patients. Shoulder dislocation caused injury to multiple nerves more often than mononeuropathies. The axillary nerve was most commonly affected, both as a single nerve and in combination with other nerves. Older patient age, higher energy of the initial trauma and longer period from dislocation to its reduction have been postulated as risk factors. Brachial plexus injury resolved spontaneously in the majority of the patients. Operative treatment was required in 13-18% of the patients in different studies. Patients with suspected neurological complications require systematic control. Surgery should be performed within 3-6 months from the injury when no signs of recovery are present.

Impact of shoulder subluxation on peripheral nerve conduction and function of hemiplegic upper extremity in stroke patients: A retrospective, matched-pair study

“…The results of this study suggest that SS may lead to more severe peripheral nerve damage in the upper extremity after stroke. Previous studies have con rmed that [20,21] , traumatic shoulder dislocation often leads to traction damage of upper limb nerves, especially axillary nerves. Anatomically, the axillary, musculocutaneous, radial and median nerves all travel/pass near the humerus [22] .…”

Simultaneous Reduction of Bilateral Anterior Shoulder Dislocation Following Nocturnal Hypoglycemia-Induced Convulsion Using the Boss-Holzach-Matter Technique

“…Essential in all reductions is relaxation and cooperation of the patient, as muscular tension is the main force that keeps the humeral head displaced [10]. It is imperative not to apply too much traction, as some techniques bear an increased risk of iatrogenic fracture or injury to the axillary nerve or brachial plexus [5, 6].…”

“…Although asymptomatic nocturnal hypoglycemia occurs relatively frequently in diabetic patients, bilateral anterior shoulder dislocation following a hypoglycemic convulsion is uncommon [1, 3, 4]. Swift, atraumatic shoulder reduction is important in relieving pain and preventing iatrogenic fracture or injury to the axillary nerve and brachial plexus [5, 6]. We present a case of bilateral anterior shoulder dislocation following a nocturnal, hypoglycemia-induced convulsion in a diabetic male, which was simultaneously reduced using the relatively uncommon, atraumatic self-reduction technique by Boss-Holzach-Matter (BHM) [7].…”

Treatment of Chronic and Complicated Ruptures of the Rotator Cuff of the Shoulder

“…Ет іологія розривів ротаторної манжети плеча (РМП) представлена різноманітними захворюван-нями, включно з віковою дегенерацією, низько-та високоенергетичною травмою [3].…”