Exposure of the brachial plexus in complex revisions to reverse total shoulder arthroplasty

Jorge Rojas, Filippo Familiari, Amrut U. Borade, Jacob Joseph, E. Gene Deune, Jack V. Ingari, Edward G. McFarland

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Excision of extensive scar tissue (EEST) may be required in certain cases of revision reverse total shoulder arthroplasty (RTSA). Neurovascular structures are at a higher risk of iatrogenic direct injury in these cases. We describe a technique to expose and protect the musculocutaneous and axillary nerves in a series of revision RTSA cases that required EEST. Methods: Between 2004 and 2013, 83 revision RTSA procedures were identified in our database. Of these, 18 cases (22%) who underwent concomitant nerve exploration for EEST preventing glenoid exposure, preventing reduction of the humeral component, or causing instability of the implanted RTSA, were included. All patients were observed for a minimum of two years or until reoperation. Patient-reported outcome scores (PROMs), range of motion (ROM), and complication rates were analyzed. Results: Patients had significant pain relief and improvement in PROMs post-operatively. Two patients (11%) required another revision surgery because of infection (one patient with glenoid loosening; one patient with stem loosening). Two patients (11%) had instability successfully managed with closed reduction. Two patients (11%) had a clinically evident post-operative nerve injury. Both cases were neurapraxias (1 partial brachial plexopathy and 1 partial isolated axillary nerve injury) and experienced complete neurologic recovery at last follow-up. Conclusions: Complete permanent nerve injuries resulting from direct surgical trauma during revision RTSA requiring EEST can be avoided using the technique presented here. Despite proper exposition of the nerves, partial temporary neurapraxic injuries may occur. Patients who underwent this procedure experienced significant improvements in shoulder pain and function with complication rates consistent to those previously reported in revision RTSA.

Original languageEnglish (US)
Pages (from-to)2789-2797
Number of pages9
JournalInternational Orthopaedics
Volume43
Issue number12
DOIs
StatePublished - Dec 1 2019

Keywords

  • Axillary nerve
  • Brachial plexus
  • Neurologic complications
  • Reverse total shoulder arthroplasty
  • Revision
  • Scar tissue

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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