We now understand that there are many possible factors that could contribute to compromised neurological function after shoulder joint replacement, including pre-existing cervical spine or shoulder nerve injuries, nerve injury from brachial plexus block, direct surgical injury, and injury from arm lengthening in reverse total shoulder. These considerations indicate the need for a complete evaluation of the patient before surgery, a detailed discussion of the risks of nerve injury with the patient, and careful attention to surgical technique.
The observation that one nerve lesion in the 41 shoulders had a new nerve lesion that had not resolved by 6 months is a concern for two reasons. One, if this rate is applied to all of the shoulder arthroplasties performed, it would indicate a rather large number of patients with iatrogenic chronic nerve injury. Secondly, the arthroplasties studied in this paper were performed by one of the most experienced shoulder surgeons in the world. It would seem likely that this nerve injury rate would be much lower than that of less experienced surgeons who perform most of the joint replacements.
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