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Nerve Injury After Shoulder Arthroscopy, Stabilization, and Rotator Cuff Repair (Axillary, Musculocutaneous, Suprascapular Nerves)

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Peripheral Nerve Issues after Orthopedic Surgery

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Abstract

While the overall incidence is low, open and arthroscopic shoulder procedures are one of the most common causes of iatrogenic nerve injuries following orthopedic surgery. Thorough knowledge of the anatomy is critical in the prevention of these injuries as the axillary, musculocutaneous, and suprascapular nerves are at risk of iatrogenic laceration or stretch injuries due to their proximity to the surgical procedures. When an injury is noted intraoperatively, consultation with a peripheral nerve surgeon is recommended as soon as possible to assess whether acute repair or grafting is warranted. Most injuries, however, involve neuropraxias, which often get better with serial examinations. A thorough physical examination is essential to help localize the lesion, while serial examinations can help to monitor and evaluate for recovery potential. Imaging and electrodiagnostic studies are indicated if symptoms worsen or fail to demonstrate measurable improvement. While many injuries will demonstrate spontaneous recovery within the first 3–6 months, there is an opportunity for surgery to repair or transfer nerves to improve function within the first year. Given the critical nature of the axillary, musculocutaneous, and suprascapular nerves in shoulder and elbow function, an early referral to a peripheral nerve surgeon is recommended within 3–6 months of injury to enhance the chance of these interventions to be the most successful.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA

    Bridget P. Pulos

  2. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA

    Nicholas Pulos

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  1. Bridget P. Pulos
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  2. Nicholas Pulos
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Correspondence to Nicholas Pulos .

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Editors and Affiliations

  1. Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA

    Christopher J. Dy

  2. Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA

    David M. Brogan

  3. Department of Orthopedic Surgery, Emory University, Atlanta, GA, USA

    Eric R. Wagner

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Pulos, B.P., Pulos, N. (2022). Nerve Injury After Shoulder Arthroscopy, Stabilization, and Rotator Cuff Repair (Axillary, Musculocutaneous, Suprascapular Nerves). In: Dy, C.J., Brogan, D.M., Wagner, E.R. (eds) Peripheral Nerve Issues after Orthopedic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-84428-8_3

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  • DOI: https://doi.org/10.1007/978-3-030-84428-8_3

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  • Online ISBN: 978-3-030-84428-8

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