An Unusual Case of Shoulder Weakness after Rotator Cuff Surgery

Abstract

HISTORY: A 69 year old male with past medical history of bilateral carpal tunnel syndrome (CTS) presented with right shoulder weakness and forearm numbness that began shortly after undergoing right rotator cuff (RC) surgery. PHYSICAL EXAMINATION: The patient appeared generally well built with atrophy of the right biceps muscles and bilateral abductor pollicis brevis muscles. No other atrophy noted to the upper extremity. Sensation was decreased in the right lateral forearm and in bilateral 1-3rd digits. There was full ROM of neck and negative Spurling's. The patient had weak elbow flexion and supination (3-/5). DIFFERENTIAL DIAGNOSIS: Brachial plexus injury Rotator cuff injury Surgical complication Cervical radiculopathy TEST AND RESULTS: - MRI of the shoulder showed postsurgical inflammatory changes to the supraspinatus tendon and RC fixation hardware that was intact. - Electrodiagnostic testing showed an axonal injury with preserved conductivity of the right musculocutaneous nerve, consistent with stretching or compression of the nerve during surgery, as well as bilateral severe CTS. FINAL WORKING DIAGNOSIS: Musculocutaneous nerve injury secondary to rotator cuff surgery with concomitant bilateral severe carpal tunnel syndrome TREATMENT AND OUTCOMES: - Physical therapy with no improvement for 6 weeks - Surgical musculocutaneous nerve repair - Ongoing physical therapy with improvement in strength after surgery