Satisfied patients after shoulder arthrodesis for brachial plexus lesions even after 20 years of follow-up

Eur J Orthop Surg Traumatol. 2018 Aug;28(6):1089-1094. doi: 10.1007/s00590-018-2152-8. Epub 2018 Feb 16.

Abstract

Purpose: Patients with an upper brachial plexus lesion can suffer from dysfunction, joint deformities and instability of the shoulder. The goal of this study was to determine pain, shoulder function, patient satisfaction and muscle strength in shoulder arthrodesis in patients with an upper brachial plexus lesion more than 15 years after surgery.

Methods: We retrospectively studied 12 patients with a brachial plexus lesion of mean age 46 years (27-61). At a mean of 19.8 years (15.4-30.3) after shoulder arthrodesis, patient-reported outcome measures (PROMs), range of motion (e.g., active and passive), patient satisfaction, strength of the affected and non-affected side (e.g., maximum isometric strength in Newton in forward and retroflexion, ab- and adduction, internal and external rotation) and position of fusion were obtained. PROMS consisted of the Visual Analogue Scale (VAS; 0-100, 0 being painless) for pain and the Disabilities of the Arm, Shoulder and Hand Score (DASH; 0-100, 0 being the best score) for function.

Results: At latest follow-up, the median VAS pain score was 49 (0-96) and 0 for, respectively, the affected and unaffected side. The DASH was 15 (8-46), meaning a reasonable to good function of the upper extremity. Active and passive retroflexion was significantly different (p = 0.028). All subjects stated that in the same situation they would undergo a shoulder arthrodesis again. The unaffected side was significantly stronger in every direction. Arthrodesis showed position of fusion of 31° (12-70) abduction, 20° (10-50) forward flexion and 22° (- 14 to 58) internal rotation. The unaffected side was significantly (p ≤ 0.05) stronger in every movement direction.

Conclusion: At a mean of 20 years after shoulder arthrodesis, patients with an upper brachial plexus lesion are still satisfied with a good to moderate functional improvement.

Level of evidence iii: A retrospective cohort study.

Keywords: Brachial plexus injury; Satisfaction; Shoulder arthrodesis; Shoulder function.

MeSH terms

  • Adult
  • Arthralgia
  • Arthrodesis*
  • Brachial Plexus Neuropathies / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Muscle Strength
  • Patient Reported Outcome Measures
  • Patient Satisfaction
  • Pilot Projects
  • Range of Motion, Articular
  • Recovery of Function
  • Retrospective Studies
  • Shoulder Joint / surgery*
  • Treatment Outcome