Prevalence and risk factors for nerve injury following shoulder dislocation

Decision Making of the In-season Athlete with Anterior Shoulder Instability

In-season management of anterior shoulder instability in athletes is a complex problem. Athletes often wish to play through their current season, though recurrent instability rates are high, particularly in contact sports. Athletes are generally considered safe to return to play when they are relatively pain-free, and their strength and range of motion match the uninjured extremity. If an athlete is unable to progress toward recovering strength and range of motion, surgical management is an option, though this is often a season-ending decision.

Reverse Shoulder Arthroplasty for Irreparable Rotator Cuff Tear After Radial to Axillary End-to-Side Transfer: A Case Report

CASE

A 60-year-old man sustained a massive irreparable rotator cuff tear and axillary nerve palsy with deltoid dysfunction after an anterior shoulder dislocation. He underwent staged reverse end-to-side radial-to-axillary nerve transfer with return of deltoid function allowing for subsequent reverse shoulder arthroplasty. At 1 year postoperatively, he returned to full activity.

CONCLUSION

Irreparable rotator cuff tears complicated by axillary nerve palsy can be effectively treated with a staged approach of nerve transfer followed by reverse shoulder arthroplasty.

Nerve Injuries after Glenohumeral Dislocation, a Systematic Review of Incidence and Risk Factors

Glenohumeral dislocation is a common shoulder injury that can result in nerve injury. However, the full impact of these injuries on patient function and recovery remains unclear. This systematic review aimed to determine (1) the incidence, (2) risk factors, and (3) functional outcomes following nerve injuries after glenohumeral dislocation. The study followed PRISMA guidelines and used the PICO strategy. PubMed, EMBASE, Scopus, and Cochrane Collaboration Library databases were searched for studies. Two reviewers independently assessed the study eligibility, and data extraction was conducted by two authors. The quality of included studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Thirteen studies comprising 17,087 patients were included. The incidence of nerve injury ranged from 0.4% to 65.5%, with the axillary nerve being most commonly affected. The time to reduction did not significantly affect the incidence of nerve injury. The mechanism of injury, the affected side, associated injuries, and recovery time were found to be potential risk factors for nerve injury. Motor recovery was incomplete in many patients, and sensory recovery was less complete. By synthesizing the available evidence, this systematic review underscores the importance of considering nerve injury in the management of patients with glenohumeral dislocations. Future research can build on these findings to develop targeted prevention and treatment approaches that optimize patient outcomes.