Disclosures: Anupam Sinha, DO: Nothing to disclose

Case Description: Patient with previous intramedullary nailing of right proximal humerus fracture, status post recent reverse ball and socket replacement with revision open reduction and fixation of proximal humerus nonunion, presents for electrodiagnostic studies. She complains of new right wrist drop and diffuse arm weakness developing after her last surgery 5 weeks ago. She denies new pain. She reports some hand tingling. Physical examination reveals complete loss of strength in right wrist extensors, biceps, triceps, deltoid, and shoulder external rotators. Reflexes are intact. No Hoffmans sign.

Setting: Orthopedic practice.

Patient: 56-year-old female.

Assessment/Results: Electrodiagnostic studies were performed of the right upper extremity. Median, ulnar, radial, and lateral antebrachial sensory responses were normal. Median and ulnar motor responses were normal. Needle EMG of the right deltoids, triceps, biceps, extensor carpi radialis, FDI, APB, infraspinatus revealed acute denervation potentials with reduced or absent recruitment. Needle study of the cervical paraspinals were normal. Patient was diagnosed with an acute right brachial plexopathy involving all three trunks of the brachial plexus, without evidence of reinnervation.

Discussion: The most common neurological injuries as a result of reverse total shoulder arthroplasty (RTSA) involve the brachial plexus or the axillary nerve. Intraoperative factors causing injury may include traction, manipulation of the arm, improper retractor placement, or relative lengthening of the arm. In addition, during intra-operative glenoid exposure, the humerus is posteriorly retracted, externally rotated, and abducted, resulting in excessive traction on the brachial plexus and axillary nerve.

Conclusion: Nerve injury following RTSA is an infrequent but known complication. Electrodiagnostic studies should be obtained after 6 weeks from the onset of post-operative weakness to assess the extent of nerve injury and should be repeated at 6 months to 1 year to follow improvement. The majority of these injuries are neuropraxic in nature, and may recover over time with physical therapy.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/brachial-plexus-injury-following-reverse-total-shoulder-arthroplasty-a-case-report/