Incidence, diagnostics and treatment algorithm of nerve lesions after traumatic shoulder dislocations: a retrospective multicenter study

Abstract

Background The shoulder is the joint most prone to dislocating in the human body and accounts for 45% of all dislocations. In addition to ruptures of the soft tissue and bony injuries, lesions to vascular structures as well as the brachial plexus and its corresponding nerves might occur. With an incidence of up to 65%, nerve lesions are frequently reported after shoulder dislocations. The aim of this study is to obtain information on epidemiology, diagnostics, treatment and duration until remission or late sequelae after shoulder dislocation and concomitant nerve injury in a large patient cohort. Methods The patient cohort consisted of 15,739 patients from three centres who had sustained a shoulder dislocation. All patient files were searched for concomitant injury of the brachial plexus or its corresponding nerves. For epidemiological data analysis, demographic data, clinical follow-ups, electromyography and nerve conduction velocity were evaluated. Results In total, 60 patients (32 males, 28 females) with a mean age of 60 years (range 19-88 years) met the inclusion criteria. In the majority of patients (n = 51), the trauma mechanism was a trivial fall on the outstretched arm. The most frequent dislocation direction was anterior-caudal in 61.6%, followed by strictly caudal in 16.6%. The brachial plexus was injured in 46 patients (76.6%) and isolated nerve damage was documented in 14 patients (23.3%). Electroneurographic examinations were performed in less than half of the patients (38.3%). Conclusion A combination injury of shoulder dislocation and plexus lesion may occur at any age and sometimes has a poor outcome. Electroneurographic examinations should be implemented when managing these patients as a cost-effective and supportive examination. Level of evidence Level IV, retrospective study.

Distribution of Peripheral Nerve Injuries in Patients with a History of Shoulder Trauma Referred to a Tertiary Care Electrodiagnostic Laboratory

“…Patients' clinical outcomes were classified as no impairment (subjectively satisfied, no problems in activities of daily living (ADLs)), mild impairment (subjectively not satisfied, no problems with ADLs), and impairment (subjectively not satisfied, problems with ADLs) [2].…”

“…The brachial plexus and its branches originate from the cervical spine, pass through the shoulder girdle, and run through the entire upper extremity [1]. The glenohumeral joint of the shoulder is a shallow ball and socket joint and is the joint with the highest mobility in the human body [2]. Shoulder trauma can cause various types of injury, such as glenohumeral joint dislocation, acromioclavicular joint injury, humeral fracture, clavicular fracture, and soft tissue injury, including rotator cuff tear [3,4].…”

Luxatio erecta of the humerus: the spectrum of injury of inferior shoulder dislocation and analysis of injury mechanisms

“…In a review of inferior dislocations, the proportion of nerve injuries was higher: 59% of the 80 cases had some degree of nerve injury 16 , the axillary nerve most commonly affected. In a multicenter study on nerve lesions after shoulder dislocations, Tiefenboeck et al found that the direction of dislocation, anterior, posterior, or inferior, did not appear to influence the rate of nerve injuries 31 . Interestingly though, in their case series of patients with nerve injuries after shoulder dislocation inferior dislocation was much more prevalent (17%) than normally would be expected 31 .…”

“…In a multicenter study on nerve lesions after shoulder dislocations, Tiefenboeck et al found that the direction of dislocation, anterior, posterior, or inferior, did not appear to influence the rate of nerve injuries 31 . Interestingly though, in their case series of patients with nerve injuries after shoulder dislocation inferior dislocation was much more prevalent (17%) than normally would be expected 31 . In our series of 27 patients, 11 had clinical signs of nerve injury, which was found to be transient in all cases (Table 3).…”

Assessment and management of shoulder dislocation

“…Most patients recover spontaneously within one year and regain muscle strength and sensation, but range of motion may be slightly limited in the injured shoulder 17. Less than 1% of patients have persistent brachial plexus and peripheral nerve injuries beyond one year, according to a retrospective multicentre study (15 739 patients) 19…”