Peripheral nerve injury associated with shoulder trauma: a retrospective study and review of the literature.

PURPOSE: To determine the incidence of peripheral nerve injury in patients referred to an electrodiagnostic laboratory with a history of shoulder trauma. The characteristics of those presenting with the triad of shoulder dislocation, peripheral nerve injury, and rotator cuff tear were further examined.

METHODS

We conducted a retrospective chart review of all patients referred to our electrodiagnostic laboratory over a 17-month period. Requisitions, clinical histories, physical findings, electrophysiological results, and radiologic investigations were reviewed. Inclusion for analysis was a clinical history of shoulder trauma and electrophysiological evidence of nerve injury.

RESULTS

Of 1844 patients studied, 48 had nerve injury associated with trauma to the shoulder. Twenty presented with brachial plexopathies; 17 isolated mononeuropathies (axillary nerve was most common, 47%); and 11 multiple nerve involvement. Of the multiple nerves involved, the axillary was most commonly affected (45% axillary and musculocutaneous; 36% axillary and suprascapular). Fifteen (31%) patients had a history of shoulder dislocation, whereas 5 (10.4%) demonstrated the triad of dislocation, nerve injury, and rotator cuff tear.

CONCLUSIONS

Peripheral nerve injury is an important consideration in patients with shoulder trauma. For patients presenting with nerve injury post-shoulder dislocation, it is important to consider a potential concomitant rotator cuff tear as an ongoing source of pain or weakness. Similarly, a patient with a rotator cuff tear following dislocation may have an associated peripheral nerve lesion.