Preventing brachial plexus injury during shoulder surgery: a real-time cadaveric study

Kam, Andrew W.; Lam, Patrick H.; Haen, Pieter Stijn; Tan, Martin; Shamsudin, Aminudin; Murrell, George A. C.

doi:10.1016/j.jse.2017.11.030

Cited by 16 publications

(8 citation statements)

References 29 publications

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“…In a cadaveric study of shoulder arthroplasty, Kam et al showed greater than 10% increased strain on the brachial plexus with combined external rotation greater than 60 and extension greater than 50 , commonly seen during humeral preparation, as well as shoulder abduction greater than 70 . 30 They also found having an unsupported arm significantly increased brachial plexus strain during the procedure. 30 Thus, avoiding excess traction in the above at-risk positions, particularly during humeral preparation, as well as a supported arm during the procedure may help protect against brachial plexus injury.…”

Section: Risk Factorsmentioning

confidence: 96%

Neurologic complications in primary anatomic and reverse total shoulder arthroplasty: A review

Vajapey

Contreras

Cvetanovich

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Section: Risk Factorsmentioning

confidence: 96%

Neurologic complications in primary anatomic and reverse total shoulder arthroplasty: A review

Vajapey

Contreras

Cvetanovich

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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“…[29][30][31][32] Kam et al demonstrated strain up to 8% in lateral and medial cords with shoulder abduction (at 80 degrees), which was exacerbated by external rotation (ER). 33 Shoulder girdle extension (movement into the dorsal plane) provides significant stretch, as does depression of the shoulder girdle. This is acknowledged in the UK guidelines where there is advice to reduce "over distention" [sic] "by allowing the shoulders to fall slightly forward (ventral) of the anterior capsule of the shoulder joint to reduce risk of brachial plexus injury.…”

Section: Infraclavicular Injurymentioning

confidence: 99%

“…29 –32 Kam et al demonstrated strain up to 8% in lateral and medial cords with shoulder abduction (at 80 degrees), which was exacerbated by external rotation (ER). 33…”

Section: Clinical Mechanisms Of Closed Nerve Injurymentioning

confidence: 99%

“…Clinicians should maintain straight spine alignment and avoid any excessive rotation 24,25 Avoid positions of extension of the shoulder or subluxation of the shoulder joint dorsally. The chest should be well supported to ensure the shoulder is forward flexed 36 Avoid positioning the arm in abduction beyond 70 degrees with elbow extension and external rotation of the shoulder beyond 60 degrees 33 Avoid extension of the neck 37 Avoiding abdominal compression to reduce venous pressure in the thoracic outlet and neck 8 …”

Section: Recommendationsmentioning

confidence: 99%

“…Avoid positioning the arm in abduction beyond 70 degrees with elbow extension and external rotation of the shoulder beyond 60 degrees 33…”

Section: Recommendationsmentioning

confidence: 99%

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Reducing the Risk and Impact of Brachial Plexus Injury Sustained From Prone Positioning—A Clinical Commentary

Simpson

Vaghela

Brown

et al. 2020

J Intensive Care Med

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Introduction: Prone positioning is deployed as a critical treatment for improving oxygenation in patients with Acute Respiratory Distress Syndrome. This regimen is currently highly prevalent in the COVID-19 pandemic. The pandemic has brought about increased concern about how best to safely avoid brachial plexus injuries when caring for unconscious proned patients. Methods: A review of the published literature on brachial plexus injuries secondary to proning ventilated patients was performed. This was combined with a review of available international critical care guidelines in order to produce a succinct set of guidelines to aid critical care departments in reducing brachial plexus injuries during these challenging times. Discussion: There is no one manner in which prone positioning an unconscious patient can be made universally safe. This paper provides 6 key steps to reducing the incidence of brachial plexus injuries while proning and suggests a safe and sensible management and referral pathway for the conscious patient in which a brachial plexus injury is identified. Conclusion: There is in truth no completely safe position for every patient and certainly there will be anomalies in anatomy that will predispose certain individuals to nerve injury. Thus the injury rate cannot be reduced to zero but an understanding of the principles of protection will inform those undertaking positioning.

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Mechanisms of Injury

Chang

2021

Operative Brachial Plexus Surgery

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Preventing brachial plexus injury during shoulder surgery: a real-time cadaveric study

Cited by 16 publications

References 29 publications

Neurologic complications in primary anatomic and reverse total shoulder arthroplasty: A review

Neurologic complications in primary anatomic and reverse total shoulder arthroplasty: A review

Reducing the Risk and Impact of Brachial Plexus Injury Sustained From Prone Positioning—A Clinical Commentary

Mechanisms of Injury

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