Results of Operative Treatment of Brachial Plexus Injury Resulting from Shoulder Dislocation: A Study with A Long-Term Follow-Up

World Neurosurg. 2017 Sep;105:623-631. doi: 10.1016/j.wneu.2017.06.059. Epub 2017 Jun 15.

Abstract

Background: Injury to the infraclavicular brachial plexus is an uncommon but serious complication of shoulder dislocation. This work aims to determine the effectiveness of operative treatment in patients with this type of injury.

Methods: Thirty-three patients (26 men and 7 women; mean age, 45 years and 3 months) treated operatively for brachial plexus injury resulting from shoulder dislocation between the years 2000 and 2013 were included in this retrospective case series. Motor function of affected limbs was assessed pre- and postoperatively with the use of the British Medical Research Council (BMRC) scale. Sensory function in the areas innervated by ulnar and median nerves was evaluated with the BMRC scale modified by Omer and Dellon and in the remaining areas with the Highet classification. Follow-up lasted 2-10 years (mean, 5.1 years).

Results: Good postoperative recovery of nerve function was observed in 100% of musculocutaneous, 93.3% of radial, 66.7% of median, 64% of axillary, and 50% of ulnar nerve injuries. No recovery was observed in 5.6% of median, 6.7% of radial, 10% of ulnar, and 20% of axillary nerve injuries. Injury to a single nerve was associated with worse treatment outcome than multiple nerve injury.

Conclusions: Obtaining improvement in peripheral nerve function after injury resulting from shoulder dislocation may require operative intervention. The type of surgical procedure depends on intraoperative findings: sural nerve grafting in cases of neural elements' disruption, internal neurolysis when intraneural fibrosis is observed, and external neurolysis in the remaining cases. The outcomes of surgical treatment are good, and the risk of intra- and postoperative complications is low.

Keywords: Brachial plexus injury; Glenohumeral dislocation; Infraclavicular brachial plexus; Nerve grafting; Neurolysis; Shoulder dislocation.

MeSH terms

  • Adult
  • Brachial Plexus / injuries*
  • Brachial Plexus / surgery*
  • Electromyography / methods
  • Electromyography / trends
  • Female
  • Follow-Up Studies
  • Humans
  • Intraoperative Neurophysiological Monitoring / methods*
  • Intraoperative Neurophysiological Monitoring / trends
  • Male
  • Middle Aged
  • Retrospective Studies
  • Shoulder Dislocation / complications*
  • Shoulder Dislocation / diagnosis
  • Shoulder Dislocation / surgery*
  • Time Factors
  • Treatment Outcome
  • Young Adult