The risk of nerve injury during anatomical and reverse total shoulder arthroplasty: an intraoperative neuromonitoring study

Parisien, Robert L.; Yi, Paul H.; Hou, Laura; Li, Xinning; Jawa, Andrew

doi:10.1016/j.jse.2016.02.016

Cited by 67 publications

(53 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results are consistent with what one would expect when performing an examination for nerve injury alone without routine EMG-NCS, and this practice represents the usual standard of care for detecting nerve injury after primary shoulder arthroplasty. Intraoperative neuromonitoring and postoperative electrodiagnostic studies have suggested that there are more subclinical injuries to the brachial plexus and individual nerves than commonly appreciated 1, 21, 26, 27. Nagda et al 26 documented episodes of nerve dysfunction in up to 57% of patients undergoing intraoperative neuromonitoring during shoulder hemiarthroplasty and TSA.…”

Section: Discussionmentioning

confidence: 99%

“…2). This arm position has been associated with nerve alerts related to brachial plexus traction 26, 27. Although external rotation alone may be helpful during subscapularis and/or capsule peel off to draw the lesser tuberosity away from the axillary nerve, 29 care was taken not to leave the arm in the extended, adducted, and externally rotated position for prolonged periods.…”

Section: Methodsmentioning

confidence: 99%

“…The rate of nerve injury for primary reverse total shoulder arthroplasty (RTSA) ranges from 2% to 8% 3, 7, 16, 28. The most commonly reported pattern of nerve injury after primary TSA or RTSA is brachial plexopathy affecting 1 or more cords 5, 16, 20, 26, 27. The second most common pattern of nerve injury is injury to individual peripheral nerves, of which the axillary nerve is the most frequently affected 2, 16, 19, 20.…”

mentioning

confidence: 99%

“…The most common cause is stretching of the plexus during surgery by positioning of the arm 14, 34. Intraoperatively, excessive time with the operative arm in external rotation and extension, with either abduction or adduction, particularly during glenoid and humeral preparation, increases the risk of nerve injury 20, 26, 27. A second possible cause is a stretch injury to the nerves caused by retractors used for visualization.…”

mentioning

confidence: 99%

“…A third mechanism is direct injury to the nerves caused by a retractor, saw, or scalpel. Other possible causes include peripheral nerve block, vascular injuries, and arm lengthening 17, 18, 20, 27, 35, 38…”

mentioning

confidence: 99%

See 4 more Smart Citations

Incidence of clinically evident isolated axillary nerve injury in 869 primary anatomic and reverse total shoulder arthroplasties without routine identification of the axillary nerve

et al. 2019

View full text Add to dashboard Cite

Background It has been suggested that, during primary shoulder arthroplasty, surgeons should identify the axillary nerve through direct visualization, palpation, or the “tug test” to prevent iatrogenic nerve injury. Our goal was to document the rate of isolated axillary nerve injury (IANI) in patients who had undergone primary anatomic total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA) without routine identification of the axillary nerve. Methods Data on 869 cases of primary shoulder arthroplasty (338 TSAs and 531 RTSAs) performed by 1 surgeon between 2003 and 2017 were reviewed. Neither the tug test nor identification of the axillary nerve through palpation or visualization was used in any case. The primary outcome was new IANI documented within 3 months after arthroplasty. The frequency of IANI was summarized using point estimates and 95% confidence intervals (CIs). Results Six cases met the criteria for IANI. The overall incidence of IANI was 0.7% (95% CI, 0.3%-1.4%). The incidence of IANI was 0.3% (95% CI, 0%-1.6%) after TSA and 0.9% (95% CI, 0.3%-2.1%) after RTSA. All IANIs were cases of neurapraxia, and all patients had experienced complete neurologic recovery at last follow-up. Conclusion Complete, permanent IANI resulting from direct surgical trauma during primary shoulder arthroplasty can be avoided without using the tug test or routine identification of the nerve. A low incidence of partial temporary IANI can be expected, which may be related to indirect traction injuries.

show abstract