Shoulder Injury and Brachial Plexus Injuries; A Prospective Evaluation of Outcomes
Matthew WT Curran, MD, MSc, Plastic and Reconstructive Surgery, University of Alberta, Edmonton, AB, Canada, Alexander Platt, MSc, MD, University of Alberta, Edmonton, AB, Canada, Michael Morhart, MSc, MD, Division of Plastic Surgery, University of Alberta, Edmonton, AB, Canada, Jaret Olson, MD, Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, AB, Canada and K. Ming Chan, MD, Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, AB, Canada
Introduction: Adult brachial plexus injuries (BPI) often result from motor vehicle accident or falls. Due to the high-energy impact, musculoskeletal structures in the shoulder girdle also liable to injury. Unless recognized promptly and treated appropriately, this could have major adverse functional impact. In a recent retrospective study, we demonstrated concomitant rotator cuff disruption in ~35%, much higher than previously reported in the literature. In this prospective study, we systematically evaluated concomitant shoulder girdle injury in all referrals to a regional peripheral nerve injury clinic and the impact of early intervention on functional outcomes.
Methods:All patients with upper limb nerve injury referred to the Central and Northern Alberta Peripheral Nerve Injury clinic between 2017 and 2019 were screened for concomitant shoulder girdle injury. Those with a history of traumatic injury and impaired shoulder function were investigated using imaging modalities including MRI, U/S or x-rays. Patients were excluded if they were pediatric, had a non-traumatic etiology, chronic rotator cuff tear, confounding neurologic diagnosis and inability to consent. Primary functional outcomes were MRC and active range of motion at final follow-up. Demographic data will be analyzed using t test and chi squared analysis for continuous and categorical data. Non-parametric statistics were used to compare upper extremity nerve injury patients with and without skeletal shoulder injury. A p value less than <0.05 will be deemed significant.
Results:Forty-five patients were recruited for the study. Average age was 46.5 +/-18.2 years. The majority were male (67%)and most had injury to the brachial plexus (67%). Sixty-two percent pf patients had a shoulder girdle injury including 31% who had full thickness rotator cuff tears. Forty-one percent of patients required operative fixation of the shoulder pathology including 15 rotator cuff repairs. This was done within 6 months of injury. MRC improved for all patients over the course of the 8 +/- 6 month follow-up (p<0.01). There was no statistical difference in final MRC scores and active range of motion between patients with and without skeletal shoulder girdle injury.
Conclusions: Concomitant musculoskeletal injury to the shoulder girdle is common in patients with upper limb nerve injury. Prompt recognition and early intervention are crucial in restoring shoulder function.
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