Patterns of Peripheral Nerve Injury in Shoulder Dislocations
Jessica Truong, MD MSc1, TA Miller, MD2, Christopher D Doherty, MD MPH FRCS(C)1 and Douglas C Ross, MD MEd FRCSC3, (1)Western University, London, ON, Canada, (2)Rehabilitation Medicine/ Hand and Upper limb Centre, St. Joseph's Health Centre, University of Western Ontario, London, ON, Canada, (3)Roth | McFarlane Hand and Upper Limb Centre, Division of Plastic Surgery, The Peripheral Nerve Clinic, London, ON, Canada
Introduction
Nerve injuries associated with shoulder dislocations significantly prolong and impair recovery. The patterns of nerve injury and their outcomes as they relate to shoulder dislocation are poorly described in current literature. The purpose of this study is to investigate patterns of nerve injury after shoulder dislocation, factors which are associated with different patterns (eg., age, sex, time to reduction, repeat dislocation), and how the aforementioned contribute to clinical outcomes.
Materials & Methods
A retrospective chart review was conducted of a specialized peripheral nerve group practice. Charts of patients who were treated between 2008 and 2018 with a peripheral nerve injury in association with shoulder dislocation were identified. Demographic data and patterns of injury were extracted. Clinical outcomes including electrodiagnostic testing, clinical muscle recovery, and requirement for surgery were documented. Correlations between injury factors and outcomes were reviewed.
Results
Fifty-four patients with shoulder dislocations associated with nerve injury were identified. Of those, 44.4% suffered a known anterior dislocation, 48.1% had an associated fracture, and 38.9% had an associated rotator cuff tear. Age greater than 60 was associated with multiple nerve injuries, whereas age less than 40 (29.6% of patients) was associated with isolated axillary nerve injuries. Overall, 59.3% of patients had brachial plexus injuries (defined by having at least two nerves involved), and 31.5% went on to have reconstructive nerve surgery predominantly in the form of nerve transfers. The majority of patients greater than age 40 with isolated axillary nerve injuries recovered spontaneously without surgery. Conversely, older patients with pan plexus injuries often had residual deficits, commonly in the ulnar nerve.
Conclusions
Shoulder dislocations may be associated with significant nerve injuries. Nearly one third of these patients will require surgical intervention. Older patients suffer more complex nerve injuries which may significantly affect global upper extremity function and be associated with residual ulnar nerve deficits.
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