Brachial Plexopathy After Removal of a Shoulder Hemiarthroplasty Prosthesis: A Serial Case Study

Abstract

Background Brachial plexopathy has been reported after shoulder arthroplasty and may be attributed to intraoperative tensioning, regional anesthesia, and other patient-specific factors. Case Presentation A 59-year-old woman presented for electrodiagnostic testing with severe right upper extremity weakness and sensory disturbance after removal of a right hemiarthroplasty humeral prosthesis 6 weeks prior. Physical examination revealed severe motor weakness and reduced sensation throughout the right upper extremity, with the greatest motor impairment in distal muscles. Outcome and Follow-Up Nerve conduction studies and electromyography (EMG) revealed a severe brachial plexopathy affecting axonal and myelin components of the lateral, medial, and posterior cords. Serial EMG and nerve conduction studies were performed 5 times over a 2-year period to inform prognosis, document neurological recovery, and guide rehabilitation. Discussion This case study demonstrates how the clinical examination, EMG, and nerve conduction studies guided diagnosis in a patient with a complex peripheral nerve lesion and details how EMG and nerve conduction studies may help predict neurological recovery. JOSPT Cases 2021;1(4):275–286. doi:10.2519/josptcases.2021.10783