Prevalence and risk factors for nerve injury following shoulder dislocation

Abstract

Background The glenohumeral joint dislocation can be associated with major nerve injury. The reported prevalence and risk factors for major nerve injury are variable and this injury can have a severe and life-long impact on the patient. The objectives of this study were to analyse the prevalence of major nerve injury following shoulder dislocation and examine risk factors. Management and outcomes of nerve injury were explored. Methods A 1 year retrospective cohort study of 243 consecutive adults who presented with a shoulder dislocation was performed. Data were collected on patient demographics, timings of investigations, treatment, follow-up, and nerve injury prevalence and management. The primary outcome measure was prevalence of nerve injury. Risk factors for this were analysed using appropriate tests with Stata SE15.1. Results Of 243 patients with shoulder dislocation, 14 (6%) had neurological deficit. Primary dislocation (p = 0.004) and older age (p = 0.02) were significantly associated with major nerve injury. Sex, time to successful reduction and force of injury were not associated with major nerve injury in this cohort. Patients with nerve injury made functional recovery to varying degrees. Recurrent shoulder dislocation was common accounting for 133/243 (55%) attendances. Conclusions Shoulder dislocation requires careful assessment and timely management in the ED. A 6% rate of nerve injury following shoulder dislocation was at the lower border of reported rates (5–55%), and primary dislocation and older age were identified as risk factors for nerve injury. We emphasise the importance of referring patients with suspected major nerve injury to specialist services.

Nerve Injuries after Glenohumeral Dislocation, a Systematic Review of Incidence and Risk Factors

“…No additional studies meeting the inclusion criteria were found upon reviewing the references of the included articles. In total, 13 studies were included in the systematic review [ 5 , 7 , 9 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ] ( Figure 1 ).…”

“…These dislocations can cause damage to the soft tissues surrounding the joint, including the rotator cuff tendons, nerves in the area, labrum, and humeral or glenoid bone lesion [ 3 , 4 ]. However, there is limited evidence regarding this association following nerve injury [ 5 , 6 , 7 ]. The close relationship between the glenohumeral joint and the brachial plexus makes nerve injury a potential complication of shoulder dislocation, with the axillary nerve being the most frequently affected nerve [ 5 , 6 ].…”

“…However, there is limited evidence regarding this association following nerve injury [ 5 , 6 , 7 ]. The close relationship between the glenohumeral joint and the brachial plexus makes nerve injury a potential complication of shoulder dislocation, with the axillary nerve being the most frequently affected nerve [ 5 , 6 ]. The axillary nerve runs inferior to the shoulder joint, providing motor innervation to the deltoid and teres minor muscles as well as sensory innervation to the skin over the inferior portion of the deltoid [ 5 , 6 ].…”

“…The close relationship between the glenohumeral joint and the brachial plexus makes nerve injury a potential complication of shoulder dislocation, with the axillary nerve being the most frequently affected nerve [ 5 , 6 ]. The axillary nerve runs inferior to the shoulder joint, providing motor innervation to the deltoid and teres minor muscles as well as sensory innervation to the skin over the inferior portion of the deltoid [ 5 , 6 ]. Damage to this nerve may cause weakness in abduction and flexion of the arm as well as loss of sensation over the deltoid.…”

Reverse Shoulder Arthroplasty for Irreparable Rotator Cuff Tear After Radial to Axillary End-to-Side Transfer

“…Axillary nerve injury is also a well-recognized complication of glenohumeral dislocations, with about 3% incidence and rising with age, time to reduction, and associated fracture 3 . Many spontaneously recover given time, but for those with high-grade nerve injury and deltoid dysfunction, it is a devastating complication with prolonged disability [3][4][5] . These pathologies in isolation have reliable treatment algorithms, but together they prove challenging to treat without clear consensus for surgical intervention.…”