Anterior dislocation of the shoulder with rotator cuff injury and brachial plexus palsy: a case report

Primary post-traumatic anterior dislocation of the shoulder with associated fracture of the greater tuberosity and brachial plexus injury is rare and, to our knowledge, has never previously been reported in the literature. We present a case of this unhappy triad in which a brachial plexus injury was diagnosed and treated 3 weeks later. The characteristics of this rare condition are discussed on the basis of our case and the published literature in order to improve early diagnosis and treatment of this lesion.

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“…Conservative management affords good recovery from these injuries over a period of up to 18 months [6, 21, 22]. …”

Section: Discussionmentioning

confidence: 99%

Fracture–dislocation of the shoulder and brachial plexus palsy: a terrible association

Chillemi¹,

Marinelli

Galizia³

2008

J Orthopaed Traumatol

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“…These changes are irreversible and surgical repair is most effective for the prevention. The prognosis of unhappy triad depends essentially on brachial plexus recovery when the rotator cuff has been repaired early [15]. In this case, it is uncertain when the rotator cuff tear occurred.…”

Section: Discussionmentioning

confidence: 99%

Concurrent Rotator Cuff Tear and Axillary Nerve Palsy Associated with Anterior Dislocation of the Shoulder and Large Glenoid Rim Fracture: A “Terrible Tetrad”

Tomita

Inui

Mifune

et al. 2014

Case Reports in Orthopedics

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We present a case of concurrent rotator cuff tear and axillary nerve palsy resulting from anterior dislocation of the shoulder and a large glenoid rim fracture—a “terrible tetrad.” A 61-year-old woman fell on her right shoulder. Radiographs showed anterior dislocation of the shoulder with a glenoid rim fracture, and an MRI two months after injury revealed a rotator cuff tear. Upon referral to our hospital, physical and electrophysiological examinations revealed axillary nerve palsy. The axillary nerve palsy was incomplete and recovering, and displacement of the glenoid rim fracture was minimal and already united; therefore, we surgically repaired only the rotator cuff tear three months after injury. The patient recovered satisfactorily following the operation. In patients whose axillary nerve palsy is recovering, surgeons should consider operating on rotator cuff tears in an attempt to prevent rotator cuff degeneration.

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“…The incidence of terrible triad varied between 2 and 18% in the analysed literature [5, 10, 11, 13-15, 17, 19, 20, 22] (Table 4). Inability to initiate abduction and weakening of external rotation of the arm should raise the suspicion of a complicated dislocation [29,70,79,81,83]. Differentiation between RCT and nerve injury as causes of shoulder disability after dislocation can be difficult based on clinical examination alone [67].…”

Section: Accompanying Injuriesmentioning

confidence: 99%

“…Robinson et al suggest that Bin the absence of GTF on postreduction radiograph, it is advisable to image the rotator cuff in patients with more complex neurological deficit^ [5]. To differentiate between RCT and nerve injury, magnetic resonance imaging (MRI), computed tomography (CT) arthrography or ultrasound should be performed as soon as possible to confirm RCT and avoid unnecessary intervention on the brachial plexus [67,83]. However, even when RCT has been diagnosed, EMG testing for nerve injury should be conducted, as the two injuries often mask each other [70,79,80].…”

Section: Accompanying Injuriesmentioning

confidence: 99%

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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Anterior dislocation of the shoulder with rotator cuff injury and brachial plexus palsy: a case report

Cited by 18 publications

References 10 publications

Fracture–dislocation of the shoulder and brachial plexus palsy: a terrible association

Fracture–dislocation of the shoulder and brachial plexus palsy: a terrible association

Concurrent Rotator Cuff Tear and Axillary Nerve Palsy Associated with Anterior Dislocation of the Shoulder and Large Glenoid Rim Fracture: A “Terrible Tetrad”

Brachial plexus injury after shoulder dislocation: a literature review

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