Distribution of Peripheral Nerve Injuries in Patients with a History of Shoulder Trauma Referred to a Tertiary Care Electrodiagnostic Laboratory.

Chul-Hyun Cho,Don-Kyu Kim,Du Hwan Kim

doi:10.3390/diagnostics10110887

Abstract

Peripheral nerve injury after shoulder trauma is an underestimated complication. The distribution of the affected nerves has been reported to be heterogeneous in previous studies. This study aimed to describe the distribution of peripheral nerve injuries in patients with a history of shoulder trauma who were referred to a tertiary care electrodiagnostic laboratory. A retrospective chart review was performed for all cases referred to a tertiary care electrodiagnostic laboratory between March 2012 and February 2020. The inclusion criteria were a history of shoulder trauma and electrodiagnostic evidence of nerve injury. Data on patient demographics, mechanism of injury, degree of weakness, clinical outcomes at the final follow-up, and electrodiagnostic results were retrieved from medical records. Fifty-six patients had peripheral nerve injuries after shoulder trauma. Overall, isolated axillary nerve injury was the most common. A brachial plexus lesion affecting the supraclavicular branches (pan-brachial plexus and upper trunk brachial plexus lesions) was the second most common injury. In cases of shoulder dislocation and proximal humerus fracture, isolated axillary nerve injury was the most common. Among acromioclavicular joint injuries and clavicular fractures, lower trunk brachial plexus injuries and ulnar neuropathy were more common than axillary nerve or upper trunk brachial plexus injuries. Patients with isolated axillary nerve lesions showed a relatively good recovery; those with pan-brachial plexus injuries showed a poor recovery. Our study demonstrated the distribution of peripheral nerve injuries remote from displaced bony structures. Mechanisms other than direct compression by displaced bony structures might be involved in nerve injuries associated with shoulder trauma. Electrodiagnostic tests are useful for determining the extent of nerve damage after shoulder trauma.

Highlights

The brachial plexus and its branches originate from the cervical spine, pass through the shoulder girdle, and run through the entire upper extremity [1]
Hems and Mahmood reported that shoulder dislocation was associated with injuries to the terminal branches of the infraclavicular brachial plexus, but Kosiyatrakul et al demonstrated that two-thirds of cases had total brachial plexus injuries, suggesting supraclavicular brachial plexus lesions [10,11]
This study aimed to describe the distribution of peripheral nerve injuries in patients with a history of shoulder trauma referred to a tertiary care electrodiagnostic laboratory and to review the literature concerning nerve injuries following shoulder trauma

Summary

Introduction

The brachial plexus and its branches originate from the cervical spine, pass through the shoulder girdle, and run through the entire upper extremity [1]. Shoulder trauma can cause various types of injury, such as glenohumeral joint dislocation, acromioclavicular joint injury, humeral fracture, clavicular fracture, and soft tissue injury, including rotator cuff tear [3,4]. Due to the anatomic proximity of the shoulder joint and brachial plexus and its branches, these injuries can affect neural structures around the shoulder joint. Diagnostics 2020, 10, 887 dislocation or humeral neck fracture has been found to be 35–65%, but the distribution of affected nerves has been reported to be heterogeneous depending on the reported study [5,6,7,8,9]. Hems and Mahmood reported that shoulder dislocation was associated with injuries to the terminal branches of the infraclavicular brachial plexus, but Kosiyatrakul et al demonstrated that two-thirds of cases had total brachial plexus injuries, suggesting supraclavicular brachial plexus lesions [10,11]

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