Mixed neuropathy presenting clinically as an anterior interosseous nerve palsy following shoulder arthroscopy: a report of four cases

Pope, David G.; Wottowa, Christopher

doi:10.1016/j.jse.2016.04.037

Cited by 7 publications

(17 citation statements)

References 26 publications

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“…The resulting compression and inflammation had significant clinical impact in their patients with preexisting at-risk anatomy such as poor nervous blood supply or baseline constrictive anatomy. 14 In our case and in all other cases shown in the table (other than those in the Pope and Wottowa study), however, the initial surgeon did not use high-pressure irrigation and the patients did not have clinical signs of distal extravasation evidenced by forearm swelling. While this makes extravasation of fluid less likely, it should be noted that the AIN fascicles in the upper arm may be vulnerable to neurologic disturbance from local fluid extravasation at the shoulder.…”

Section: Discussionmentioning

confidence: 44%

“…The initial search yielded six results for AIN palsy after shoulder arthroscopy, and after screening, four articles were selected for review. 6,14-16 Two studies were excluded because: (1) patient had not undergone shoulder arthroscopy before developing symptoms; and (2) patient presentation was not consistent with AIN palsy. Publication dates ranged from 2007 to 2016 and consisted primarily of case series.…”

Section: Resultsmentioning

confidence: 99%

“…26 In an article by Pope and Wottowa, there were four cases of mixed peripheral neuropathy that presented primarily as AIN palsy following ipsilateral shoulder arthroscopy. 14 They found that one constant between the four patients was fluid extravasation from the arthroscopy. They concluded that intrafasicular or extrafasicular pressure in or around the median or AIN in the forearm increased as fluid tracked distally.…”

Section: Discussionmentioning

confidence: 98%

“…Of the 14 cases included in this review, 9 were positioned in the left lateral decubitus (LLD) position, 4 were positioned in the beach chair, and 1 patient’s positioning was unknown. 6,14-16 Three of the four patients positioned in the beach chair were from the Pope series and this was the only series to specifically state there was fluid extravasation during the arthroscopy. 14 It is worth noting that this is also the only study in which a mixed peripheral neuropathy (primarily clinically manifested as AIN palsy) was found as all the other studies were purely AIN palsy.…”

Section: Discussionmentioning

confidence: 99%

“…6,14-16 Three of the four patients positioned in the beach chair were from the Pope series and this was the only series to specifically state there was fluid extravasation during the arthroscopy. 14 It is worth noting that this is also the only study in which a mixed peripheral neuropathy (primarily clinically manifested as AIN palsy) was found as all the other studies were purely AIN palsy. 6,14-16…”

Section: Discussionmentioning

confidence: 99%

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Anterior Interosseous Nerve Palsy After Shoulder Arthroscopy Treated With Surgical Decompression: A Case Series and Systematic Review of the Literature

Nammour

Desai²,

Warren

et al. 2019

Hand (New York, N,Y.)

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Background: Anterior interosseous nerve (AIN) palsy is a very uncommon cause of upper extremity pain and weakness that comprises less than 1% of all upper extremity nerve palsies. Rarely reported but also mentioned in the literature is AIN palsy after shoulder arthroscopy. Methods: A systematic review of the literature to date using PubMed was conducted to identify patients who suffered AIN palsy after shoulder arthroscopy procedures. Articles included met the following criteria: (1) published in English; (2) primary presentation of the data; (3) patients had undergone shoulder arthroscopy before developing symptoms of AIN palsy; and (4) diagnosis was confirmed with clinical symptoms of AIN palsy. Measured outcomes included patient demographics, specific shoulder procedure, anesthesia procedure, intra-operative patient positioning, intra-operative compressive dressing, intra-operative traction, surgical versus conservative treatment, abnormal findings during decompression procedure, proposed mechanism of injury, and follow-up. Results: The search yielded 6 articles, of which 4 (13 cases) met inclusion criteria. An additional 2 cases were included in this report totaling 15 cases. The average patient age was 49 years (range: 31-64) with 73% males. At average follow-up of 24 months, 67% of patients experienced complete resolution of symptoms—more than half of which underwent surgical decompression. Patients who failed to progress experienced weakness of the flexor digitorum profundus and flexor pollicis longus muscles. Conclusions: Proposed injury mechanisms for AIN palsy after shoulder arthroscopy range from mechanical trauma, compressive hematoma, and direct anesthetic neurotoxicity. Management should be directed by clinical symptoms, imaging, and patient factors with majority of patients expected to have excellent clinical outcomes.

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Section: Discussionmentioning

confidence: 44%