Regarding “Distal peripheral neuropathy after open and arthroscopic shoulder surgery: an under-recognized complication”

Abstract

Thomasson et al 3 Thomasson B.G. Matzon J.L. Pepe M. Tucker B. Maltenfort M. Austin L. Distal peripheral neuropathy after open and arthroscopic shoulder surgery: an under-recognized complication. J Shoulder Elbow Surg. 2015; 24: 60-66https://doi.org/10.1016/j.jse.2014.08.007 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar studied distal peripheral neuropathy (DPN) after shoulder surgery. They note that, “Determination of when DPN is related to the surgery vs an unrelated finding is difficult.” Yet, there are several places in their report where DPN is referred to as an injury. Given what is known about cubital and carpal tunnel syndrome, it is highly likely that most if not all of these diagnoses represent previously asymptomatic disease and are not injuries. More than half of patients with cubital tunnel syndrome present with advanced neuropathy with weakness or atrophy. 2 Mallette P. Zhao M. Zurakowski D. Ring D. Muscle atrophy at diagnosis of carpal and cubital tunnel syndrome. J Hand Surg Am. 2007; 32: 855-858https://doi.org/10.1016/j.jhsa.2007.03.009 Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar Among patients with severe carpal tunnel syndrome, 85% have contralateral carpal tunnel syndrome as well, often asymptomatic. 1 Hoogstins C.E. Becker S.J. Ring D. Contralateral electrodiagnosis in patients with abnormal median distal sensory latency. Hand (N Y). 2013; 8: 434-438https://doi.org/10.1007/s11552-013-9532-7 Crossref PubMed Scopus (6) Google Scholar These are common diseases that progress slowly. Patients often adapt and are asymptomatic until later stages of the pathophysiology. The surgery is likely coincidental or merely brings the problem to the patient's attention. Prospective studies with careful examination, Semmes-Weinstein monofilament testing, and perhaps electrodiagnostic testing before and after shoulder surgery are warranted to determine when cubital and carpal tunnel syndrome are directly related to shoulder surgery.