Results of operative treatment of brachial plexus injury resulting from shoulder dislocation - a study with a long-term follow up.

Results of operative treatment of brachial plexus injury resulting from shoulder dislocation - a study with a long-term follow up.

World Neurosurg. 2017 Jun 14;:

Authors: Gutkowska O, Martynkiewicz J, Mizia S, Bąk M, Gosk J

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 males,7 females; mean age 45 years 3 months) treated operatively for brachial plexus injury resulting from shoulder dislocation between the years 2000-2013 were included in this retrospective case series. Motor function of affected limbs was assessed pre- and postoperatively with the use of BMRC (British Medical Research Council) scale. Sensory function in the areas innervated by ulnar and median nerves was evaluated with BMRC scale modified by Omer and Dellon and in the remaining areas with Highet's 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 grafiting in cases of neural elements' disruption, internal neurolysis when itraneural 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.

PMID: 28624567 [PubMed - as supplied by publisher]

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