Intraoperative nerve monitoring during total shoulder arthroplasty surgery (original) (raw)
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Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.], 2016
This study compared the incidence and pattern of potential nerve injuries between reverse shoulder (RSA) and total shoulder arthroplasty (TSA) using intraoperative neuromonitoring. Our hypothesis was that RSA has a greater risk of nerve injury than TSA due to arm lengthening. We reviewed 36 consecutive patients who underwent RSA (n = 12) or TSA (n = 24) with intraoperative neuromonitoring. The number of nerve alerts was recorded for each stage of surgery. Neurologic function was assessed preoperatively and postoperatively at routine follow-up visits. Predictive factors for increased intraoperative nerve alerts and clinically detectable neurologic deficits were determined. There were nearly 5 times as many postreduction nerve alerts per patient in the RSA cohort compared with the TSA cohort (2.17 vs. 0.46). There were 17 unresolved nerve alerts postoperatively, with only 2 clinically detectable nerve injuries, which fully resolved by 6 months postoperatively. A preoperative decrease ...
Journal of Shoulder and Elbow Surgery, 2021
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Journal of clinical monitoring and computing, 2017
To report the incidence of clinically detectable nerve injuries when utilizing transcranial electrical motor evoked potentials (MEPs) during shoulder arthroplasty. A retrospective review of patients undergoing shoulder arthroplasty with continuous IONM was performed. The criteria for nerve alerts was an 80% amplitude reduction in MEPs. The primary outcome measure was post-operative clinically detectable nerve deficit. An additional retrospective analysis on a subset of cases using an all-or-none (100% amplitude reduction) criterion applied to the deltoid was performed. Two hundred eighty four arthroplasty cases were included. There were no permanent post-operative nerve injuries and two transient nerve injuries (0.7%). MEP alerts occurred in 102 cases (36.2%). Nineteen (6.7%) cases did not have signals return above alert threshold at closure. These cases were significantly associated with post-operative nerve injury (p = 0.03). There were no false negatives, making sensitivity 100% ...
Automated Nerve Monitoring in Shoulder Arthroplasty: A Prospective Randomized Controlled Study
Anesthesiology, 2021
Evoked potential monitoring is believed to prevent neurologic injury in various surgical settings; however, its clinical effect has not been scrutinized. It was hypothesized that an automated nerve monitor can minimize intraoperative nerve injury and thereby improve clinical outcomes in patients undergoing shoulder arthroplasty. A prospective, blinded, parallel group, superiority design, single-center, randomized controlled study was conducted. Study participants were equally randomized into either the automated nerve-monitored or the blinded monitored groups. The primary outcome was intraoperative nerve injury burden as assessed by the cumulative duration of nerve alerts. Secondary outcomes were neurologic deficits and functional scores of the operative arm, and the quality of life index (Euro Quality of life-5 domain-5 level score) at postoperative weeks 2, 6, and 12. From September 2018 to July 2019, 213 patients were screened, of whom 200 were randomized. There was no statistica...
Nerve injury associated with shoulder surgery
Current Orthopaedics, 2008
Although generally low, the risk of damage to nerves in the operative field during shoulder surgery still exists. These complications usually occur following surgery for anterior shoulder instability or joint replacement. The risk can be minimized by careful patient positioning, applying a detailed knowledge of shoulder anatomy to the approach and awareness of 'safezones'. Certain manoeuvres should be undertaken during the procedure to displace nerves from the operative field. If these measures are incorporated into routine practice, the risk of intraoperative nerve injury will be significantly reduced. Crown
SHOULDER AND ELBOW Nerve injury associated with shoulder surgery
0268-0890/$ see front matter Crown doi:10.1016/j.cuor.2008.04.009 Summary Although generally low, the risk of damage to nerves in the operative field during shoulder surgery still exists. These complications usually occur following surgery for anterior shoulder instability or joint replacement. The risk can be minimized by careful patient positioning, applying a detailed knowledge of shoulder anatomy to the approach and awareness of ‘safezones’. Certain manoeuvres should be undertaken during the procedure to displace nerves from the operative field. If these measures are incorporated into routine practice, the risk of intraoperative nerve injury will be significantly reduced. Crown Copyright a 2008 Published by Elsevier Ltd. All rights reserved.
Iatrogenic Nerve Injuries in Shoulder Surgery
Journal of the American Academy of Orthopaedic Surgeons, 2013
The range of open and arthroscopic shoulder procedures continues to evolve and expand. Despite advances in instrumentation and technology, complications still exist and neurologic injury remains an inherent part of these procedures. Iatrogenic nerve injuries are among the more commonly cited complications associated with shoulder surgery. Various surgical procedures about the shoulder are known to place the brachial plexus and peripheral motor nerves at risk. Peripheral nerve monitoring has been helpful in identifying specific surgical steps and key anatomic regions that are susceptible to iatrogenic nerve injury.
Injury, 2017
Implantation of a reverse total shoulder arthroplasty (rTSA) places the axillary and suprascapular nerves at risk. The aim of this anatomic study was to digitally analyse the location of these nerves in relation to bony landmarks in order to predict their path and thereby help to reduce the risk of neurological complications during the procedure. A total of 22 human cadaveric shoulder specimens were used in this study. The axillary and suprascapular nerves were dissected, and radiopaque threads were sutured onto the nerves without mobilizing the nerves from their native paths. Then, 3D X-ray scans of the specimens were performed, and the distance of the nerves to bony landmarks at the humerus and the glenoid were measured. The distance of the inferior glenoid rim to the axillary nerve averaged 13.6mm (5.8-27.0mm, ±5.1mm). In the anteroposterior direction, the distance between the axillary nerve and the humeral metaphysis averaged 8.1mm (0.6-21.3mm, ±6.5mm). The distance of the gleno...