Isolated Radial Nerve Palsy as a Complication After Anterior Dislocation of the Glenohumeral Joint: A Case Report and Clinical Review

Abstract

Shoulder dislocation is the most common feature in emergencies, while the anterior dislocation of the glenohumeral joint is the most frequent and requires reduction. Accompanied nerve injury is common with an incidence of 21%, while radial nerve palsy is very rare. We describe the case of a 56-year-old man who presented with an anterior dislocation of the left shoulder due to a fall on an outstretched hand with wrist drop 8 hours after injury. Neurological examination revealed loss of sensation along the radial border of the forearm. Closed reduction with Kocher procedure was performed. Magnetic resonance image demonstrated a rotator cuff tear, and 3 weeks after the injury electromyography showed complete radial nerve palsy. A physiotherapy program was applied to the wrist and fingers with the goal of maintaining a full passive range of motion in all joints affected while shoulder rehabilitation started 6 weeks after his fall. Isolated radial nerve palsy associated with an anterior dislocation of the shoulder is very rare but not impossible to occur. Correct diagnosis of the nerve injury associated with the anterior dislocation is very important because it has serious implications on the management and activity morbidity.

How COVID-19 Pandemic Affected the Treatment and Rehabilitation of Distal Radius Fracture? Data from a Peripheral General Hospital in Crete

“…Distal radius fractures constitute a common orthopaedic trauma met in emergency department and a remarkable social problem. Most patients with DRF trauma seeking medical help in emergency department need surgical treatment if meeting certain criteria as displaced distal radius fracture with an intra-articular step of more than 2mm, radial shortening more than 2mm, dorsal tilt more than15 degree, incongruence in distal radio-ulnar joint in preoperative x-rays or ct/scan and bilateral DRF [2] .…”

“…Distal radius fracture (DRF) is the most common injury in emergency department with an incidence of 36.8/10 persons per year in women and 9.0/10 persons per year in men over 35 years old rising in 9% by the age of 90years [1,2] . Huetteman et al suggested that the average cost of care for a distal radius fracture patient was up to eight thousand dollars in the United States during 2009-2015 [1] .…”

“…The distribution of these fractures depends on the age and the mechanism of injury. In geriatric patients, over 65 years old, with women having a higher risk than men of 15%, DRF occur after a low energy trauma, usually a fall from standing height, due to frailty and osteoporotic factors [2] , On the other hand, in younger subjects the fracture is a result of high energy trauma due to a vehicle accident, fall from a height or work-related accidents and they usually suffer from comminute or displaced fractures which require definite surgical management. In stable distal radius fractures conservative treatment after closed reduction and immobilization in a plaster of Paris cast for 4-6 weeks to maintain an anatomical alignment is the elective treatment.…”

“…In cases of unstable fractures following some criteria suggested by Lafontaine et al (age˃60 years, dorsal angulations>20°, dorsal comminution, fracture extension into the radiocarpal joint with intra-articular step-off more than 2mm and associated ulnar fracture), surgical treatment is the elective procedure to restore radial bone articular surface and alignment in the wrist joint and prevent dysfunction. The most popular surgical technique is internal fixation with volar locking plate [2] .…”

Radial nerve palsy following uncomplicated percutaneous nephrolithotomy

“…(Wang et al, 2009) In order to preserve a complete passive range of motion in all joints and then he began physiotherapy for the wrist and ingers. (Kastanis et al, 2019) The ROM of the shoulders ( lexion, extension, abduc-tion, rotation), elbows ( lexion, extension, supination, pro-nation), and wrists ( lexion, extension) was measured with a standard goniometer. (Ekholm et al, 2008) At 4 weeks, mobilization begins.…”