The risk of nerve injury during anatomical and reverse total shoulder arthroplasty: An intraoperative neuromonitoring study

Robert L. Parisien, Paul H. Yi, Laura Hou, Xinning Li, Andrew Jawa

Research output: Contribution to journalArticlepeer-review

Abstract

Background: This study compared the incidence and pattern of potential nerve injuries between reverse shoulder (RSA) and total shoulder arthroplasty (TSA) using intraoperative neuromonitoring. Our hypothesis was that RSA has a greater risk of nerve injury than TSA due to arm lengthening. Methods: We reviewed 36 consecutive patients who underwent RSA (n = 12) or TSA (n = 24) with intraoperative neuromonitoring. The number of nerve alerts was recorded for each stage of surgery. Neurologic function was assessed preoperatively and postoperatively at routine follow-up visits. Predictive factors for increased intraoperative nerve alerts and clinically detectable neurologic deficits were determined. Results: There were nearly 5 times as many postreduction nerve alerts per patient in the RSA cohort compared with the TSA cohort (2.17 vs. 0.46). There were 17 unresolved nerve alerts postoperatively, with only 2 clinically detectable nerve injuries, which fully resolved by 6 months postoperatively. A preoperative decrease in active forward flexion and the diagnosis of rotator cuff arthropathy were independent predictors of intraoperative nerve alerts. Conclusion: RSA has a higher incidence of intraoperative nerve alerts than TSA during the postreduction stage due to arm lengthening. Decreased preoperative active forward flexion and the diagnosis of rotator cuff arthropathy are predictors of more nerve alerts. The clinical utility of routine intraoperative nerve monitoring remains in question given the high level of nerve alerts and lack of persistent postoperative neurologic deficits.

Original languageEnglish (US)
Pages (from-to)1122-1127
Number of pages6
JournalJournal of Shoulder and Elbow Surgery
Volume25
Issue number7
DOIs
StatePublished - Jul 1 2016
Externally publishedYes

Keywords

  • Anatomic
  • Arthroplasty
  • Level II
  • Motor evoked potential
  • Nerve injury
  • Nerve monitoring
  • Prognosis Study
  • Reverse
  • Somatosensory evoked potential

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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