Nerve lesions in primary shoulder dislocations and humeral neck fractures. A prospective clinical and EMG study

Laat, E. A. T. de; Visser, Cornelis P.J.; Coene, L. N. J. E. M.; Pahlplatz, Paul V. M.; Tavy, D.L.J.

doi:10.1302/0301-620x.76b3.8175837

Cited by 171 publications

(108 citation statements)

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“…However, injuries resulting from shoulder dislocation affect predominantly the infraclavicular part of the plexus at the level of cords and nerves, often extending up to retropectoralis minor space [11,65,66]. It may be explained by the fact that trauma in abduction causes primarily injury to the lower part of the brachial plexus [64].…”

Section: Affection Of Particular Nervesmentioning

confidence: 99%

“…Shoulder dislocation most commonly causes injury to the axillary nerve, both when single nerve injury is considered and in combination with other nerves [5,11,16,18,42]. Axillary nerve was found to be affected in all patients with neurologic deficit after shoulder dislocation (100%) in several studies [6,7,22,23,51,[67][68][69][70], and in all analysed studies but two (Hems and Mahmood, Stenning et al), it occupied the first place among injuries to the long nerves of the brachial plexus [18,54].…”

Section: Affection Of Particular Nervesmentioning

confidence: 99%

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Brachial plexus injury after shoulder dislocation: a literature review

et al. 2018

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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.

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Section: Affection Of Particular Nervesmentioning

confidence: 99%

Section: Affection Of Particular Nervesmentioning

confidence: 99%

Brachial plexus injury after shoulder dislocation: a literature review

et al. 2018

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“…4,23 The prevalence of electrophysiologically documented nerve damage associated with closed shoulder trauma is reported to be up to 62% and most frequently involves the axillary nerve. 10 Occasionally, the axillary nerve is damaged during reduction of a shoulder dislocation. After glenohumeral dislocation, transient axillary numbness is often noted.…”

Section: Mechanism Of Injurymentioning

confidence: 99%

Axillary nerve injury associated with sports

Lee

Saetia

Saha

et al. 2011

FOC

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Object The aim of this retrospective study was to present and investigate axillary nerve injuries associated with sports. Methods This study retrospectively reviewed 26 axillary nerve injuries associated with sports between the years 1985 and 2010. Preoperative status of the axillary nerve was evaluated by using the Louisiana State University Health Science Center (LSUHSC) grading system published by the senior authors. Intraoperative nerve action potential recordings were performed to check nerve conduction and assess the possibility of resection. Neurolysis, suture, and nerve grafts were used for the surgical repair of the injured nerves. In 9 patients with partial loss of function and 3 with complete loss, neurolysis based on nerve action potential recordings was the primary treatment. Two patients with complete loss of function were treated with resection and suturing and 12 with resection and nerve grafting. The minimum follow-up period was 16 months (mean 20 months). Results The injuries were associated with the following sports: skiing (12 cases), football (5), rugby (2), baseball (2), ice hockey (2), soccer (1), weightlifting (1), and wrestling (1). Functional recovery was excellent. Neurolysis was performed in 9 cases, resulting in an average functional recovery of LSUHSC Grade 4.2. Recovery with graft repairs averaged LSUHSC Grade 3 or better in 11 of 12 cases Conclusions Surgical repair can restore useful deltoid function in patients with sports-associated axillary nerve injuries, even in cases of severe stretch–contusion injury.

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“…The axillary nerve is reportedly the most susceptible to injury after fractures with and without dislocation of the proximal humerus [27]. Several studies have reported using nerve monitoring in the asessment of proximal humerus fractures [6,28,30]. de Laat et al found electrophysiologic evidence of nerve injury in 45% of cases (n = 101) [6].…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have reported using nerve monitoring in the asessment of proximal humerus fractures [6,28,30]. de Laat et al found electrophysiologic evidence of nerve injury in 45% of cases (n = 101) [6]. Visser et al reported axonal nerve lesions in proximal humeral fractures were much more common than has been reported in the literature: EMGs showed axonal denervation in 67% (96 of 143) of the patients and solitary nerve injury was seen in 21 of 143 cases [30].…”

Section: Introductionmentioning

confidence: 99%

Nerve Monitoring During Proximal Humeral Fracture Fixation: What Have We Learned?

Warrender

Oppenheimer

Abboud

2011

Clinical Orthopaedics &Amp; Related Research

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Background The incidence of neurologic injury after proximal humerus fractures is variable, ranging from 6.2% to as much as 67%. However, it is unclear what factors might contribute to these injuries or whether they can be prevented by intraoperative nerve monitoring. Questions/purposes Therefore, using intraoperative nerve monitoring, we assessed the incidence, pattern of nerve involvement, and predisposing factors for nerve injury before and during shoulder fracture fixation. Patients and Methods We used continuous intraoperative monitoring of the brachial plexus in 37 patients undergoing open operative treatment of proximal humerus fractures. Impending intraoperative compromise of nerve function was signaled by sustained neurotonic EMG activity or greater than 50% amplitude attenuation of transcranial electrical motor evoked potentials (MEPs) (or both). When a nerve alert occurred, current surgical activity and arm and retractor position were recorded and adjustments were made to relieve tension.

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Nerve lesions in primary shoulder dislocations and humeral neck fractures. A prospective clinical and EMG study

Cited by 171 publications

References 0 publications

Brachial plexus injury after shoulder dislocation: a literature review

Brachial plexus injury after shoulder dislocation: a literature review

Axillary nerve injury associated with sports

Nerve Monitoring During Proximal Humeral Fracture Fixation: What Have We Learned?

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