Results of Operative Treatment of Brachial Plexus Injury Resulting from Shoulder Dislocation: A Study with A Long-Term Follow-Up

Gutkowska, Olga; Martynkiewicz, Jacek; Mizia, Sylwia; Bąk, Michał; Gosk, Jerzy

doi:10.1016/j.wneu.2017.06.059

Cited by 12 publications

(11 citation statements)

References 30 publications

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“…The above-cited data refers to a subgroup of 33 patients who completed a 2-year follow-up. Detailed information regarding the results of operative treatment obtained in this patient group was presented in another publication [ 8 ].…”

Section: Resultsmentioning

confidence: 99%

Analysis of Patient-Dependent and Trauma-Dependent Risk Factors for Persistent Brachial Plexus Injury after Shoulder Dislocation

Gutkowska

Martynkiewicz

Stepniewski

et al. 2018

BioMed Research International

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Brachial plexus injuries (BPIs) caused by shoulder dislocation usually have a transient character and tend to resolve spontaneously. However, in some patients the symptoms can persist and require operative intervention. This work aims to determine the risk factors for persistent BPIs resulting from shoulder dislocation. The study comprised 73 patients (58 men, 15 women; mean age: 50 years) treated operatively between the years 2000 and 2016 for persistent BPIs resulting from shoulder dislocation. Patient age, gender, type of initial trauma, number of affected nerves, presence of accompanying injuries, and time interval from dislocation to its reduction were analysed. Elderly patients more often sustained multiple-nerve injuries, while single nerve injuries were more often observed in younger patients. Injury to a single nerve was diagnosed in 30% of the patients. Axillary nerve was most commonly affected. Fracture of the greater tuberosity of humerus coincided with total BPI in 50% of the cases. Longer unreduced period caused injury to multiple nerves. Analysis of our patient group against relevant literature revealed that persistent BPI after shoulder dislocation is more common in older patients. Injuries to ulnar and median nerves more often require operative intervention due to low potential for spontaneous recovery of these nerves.

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Section: Resultsmentioning

confidence: 99%

Analysis of Patient-Dependent and Trauma-Dependent Risk Factors for Persistent Brachial Plexus Injury after Shoulder Dislocation

Gutkowska

Martynkiewicz

Stepniewski

et al. 2018

BioMed Research International

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“…Inferior results and longer time required for recovery of the median and ulnar nerves have been observed by many authors [9,18,31,37,77,78].…”

Section: Factors Influencing Recoverymentioning

confidence: 74%

“…Careful pre-and intraoperative assessment of the severity and type of nerve lesion is extremely important, because unnecessary resection of a regenerating brachial plexus element or performing solely neurolysis of elements for which there is no chance for regeneration does the patient a great harm [99]. External neurolysis is sufficient in cases with nerve continuity and present regenerative nerve action potentials (NAPs) [60,78,112]. In such cases, the reason for impairment or loss of limb function is external scarring (fibrosis) causing compression on the elements of the brachial plexus.…”

Section: Preferred Operative Methodsmentioning

confidence: 99%

“…Neurolysis needs to be performed in a subtle manner in order to avoid fascicular devascularisation [113]. Additional internal neurolysis is required when severe neuropathic pain accompanies or when thickened epineurium compressing nerve bundles and causing compromise of vasa nervorum is observed intraoperatively [60,78,112,114,115]. When disruption of nerve continuity is observed or regenerative NAPs are absent in a continuous nerve, grafting (usually with the use of sural nerve) should be implemented.…”

Section: Preferred Operative Methodsmentioning

confidence: 99%

“…When disruption of nerve continuity is observed or regenerative NAPs are absent in a continuous nerve, grafting (usually with the use of sural nerve) should be implemented. However, according to some authors, nerve resection and grafting are not recommended during primary operative intervention, because in certain injury patterns improvement in nerve function after operation is possible only after axon regeneration (enabled by restoration of blood flow to the nerve by means of neurolysis) has been completed [77,78,94]. During operative exploration of the injured brachial plexus, anatomic relations of particular structures are usually altered due to the presence of a fibrous scar [94].…”

Section: Preferred Operative Methodsmentioning

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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Controversies in NTOS: What Is the Evidence Supporting Brachial Plexus Neurolysis and Wrapping

Dargan

Illig

2021

Thoracic Outlet Syndrome

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Results of Operative Treatment of Brachial Plexus Injury Resulting from Shoulder Dislocation: A Study with A Long-Term Follow-Up

Cited by 12 publications

References 30 publications

Analysis of Patient-Dependent and Trauma-Dependent Risk Factors for Persistent Brachial Plexus Injury after Shoulder Dislocation

Analysis of Patient-Dependent and Trauma-Dependent Risk Factors for Persistent Brachial Plexus Injury after Shoulder Dislocation

Brachial plexus injury after shoulder dislocation: a literature review

Controversies in NTOS: What Is the Evidence Supporting Brachial Plexus Neurolysis and Wrapping

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