Shoulder arthroplasty and postoperative neuropathy

Is Distal Peripheral Neuropathy More Common After ShoulderArthroplasty?

These authors report on the incidence of distal peripheral neuropathy requiring surgical intervention following shoulder arthroplasty. Distal peripheral neuropathy was defined as symptoms or diagnostic testing consistent with cubital tunnel or carpal tunnel syndrome. 

1,387 total shoulder arthroplasties were included in this study. 16 patients (1.2%) underwent surgery for ipsilateral peripheral neuropathy while 6 patients (0.4%) underwent surgery for contralateral peripheral neuropathy.

Comment: This study may have underestimated the incidence of post operative neuropathy for several reasons: (1) Patients were included in the series only if they had primary surgical intervention for ipsilateral or contralateral peripheral neuropathy following primary anatomic or reverse total shoulder arthroplasty. (2)  Patients were not systematically examined for evidence of neurological abnormalities. (3) Patients with symptoms of peripheral neuropathy, but who did not undergo surgery for the neuropathy were not considered. (4) Not all peripheral neuropathies present as symptoms of cubital or carpal tunnel syndromes.

The brachial plexus is at risk during shoulder arthroplasty because of (1) nerve laceration, (2) nerve compression from retractors, (3) nerve traction, (4) arm lengthening, and (5) neck positioning during the surgery.

In this series, it appears that brachial plexus block anesthesia was used. This intervention carries an additional risk of peripheral nerve injury as revealed in this study, The types and severity of complications associated with interscalene brachial plexus block anesthesia: local and national evidence. Here is the abstract from that article: 

"Interscalene brachial plexus block is a commonly used anesthetic. However, substantial complications can be associated with its use. Our study included 15 years of data from a local medical center and 3 decades of records from the national American Society of Anesthesiology Closed Claims Project. The hospital had 27 peripheral neurologic injuries, 3 central nervous system complications, 6 respiratory complications, and 5 cardiovascular complications. Of these complications, 14 were still present at the most recent follow-up, some causing major compromise of the patient's comfort and function. All central blocks, local toxicities, and respiratory complications resolved. In the hospital series, more experienced anesthesiologists tended to have lower complication rates. The American Society of Anesthesiology Closed Claims database had 20 peripheral neurologic injuries, 10 respiratory complications, 5 central nervous system complications, 4 deaths, 2 emotional disturbances, and 1 other unknown event. Of the complications, 19 were described as permanent. Interscalene brachial plexus block can be accompanied by substantial and disabling complications, especially when administered by less experienced anesthesiologists."

See also these articles: link 1 and link 2

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Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link).

How to x-ray the shoulder (see this link).

The ream and run procedure (see this link).

The total shoulder arthroplasty (see this link).

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

The smooth and move procedure for irreparable rotator cuff tears (see this link).

Shoulder rehabilitation exercises (see this link).

Reverse total shoulder - 19% neurological deficits

Neurologic deficit after reverse total shoulder arthroplasty: correlation with distalization

These authors assessed the prevalence and outcomes of neurologic deficit after reverse total shoulder ( RTSA) and evaluated the correlation between nonanatomic rearrangement of the shoulder joint and neurologic complications after RTSA.

Patients were evaluated clinically for neurologic deficits after the surgery. Electromyography (EMG) and nerve conduction velocity (NCV) were performed 4 weeks postoperatively.

Neurologic deficit after RTSA was found in 34 shoulders (19%). 

The mean postoperative acromiohumeral distance was 34 mm patients with nerves deficits  and 29 mm patients without nerve deficits. 

Significant differences in terms of postoperative distalization of the humerus were seen between those shoulders with neuro deficits  (24.5  mm) and those without (20.5).

 The most common forms of neurologic deficit after RTSA were axillary nerve (41.2%) and radial nerve (15%) injuries. 

Thirty shoulders (88%) had neuropraxia, and 4 shoulders (12%) had axonotmesis. 

By conservative treatment, all patients with neurologic complications achieved complete recovery without any additional surgery; the mean recovery period was 7.4 months (range: 2-38 months).

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You may be interested in some of our most visited web pages  arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

Do shoulders with massive cuff tears have supra scapular neuropathy

Neuropathy of the suprascapular nerve and massive rotator cuff tears: a prospective electromyographic study

Prior authors have suggested the need for releasing the suprascapular nerve when massive cuff tears are repaired. These authors prospectively evaluated the suprascapular nerve for preoperative neurodiagnostic abnormalities in shoulders with massive cuff tears. 49 patients with retracted tears of both supraspinatus and infraspinatus were evaluated.

6 (12%) had neurologic lesions noted on electromyography: 1 radicular lesion of the C5 root, 1 affected electromyogram in the context of a previous stroke, 3 cases of partial axillary nerve palsy with a history of shoulder dislocation; only 1 had suprascapular nerve neuropathy.

This study does not support the need for routine suprascapular nerve release in cuff repair.

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Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

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