Summary

This study retrospectively reviewed the incidence of peripheral neuropathy following shoulder arthroplasty, revealing a 1.5% incidence of peripheral neuropathy requiring surgical intervention.

Abstract

Introduction

Peripheral neuropathy following shoulder arthroplasty has been described, although no direct causality has been established. Most studies have examined the incidence of nerve injury about the shoulder including brachial plexopathy, musculocutaneous nerve injury, axillary nerve injury, or suprascapular nerve injury. However, neuropathy of the median and ulnar nerve can result in morbidity and dissatisfaction following shoulder arthroplasty. Existing studies report a 0-5% incidence of peripheral neuropathy following shoulder arthroplasty. The goal of this study is to retrospectively report on the incidence of compressive peripheral neuropathy requiring operative treatment after shoulder arthroplasty.

Methods

A retrospective review was conducted from a shoulder arthroplasty registry (anatomic total shoulder or reverse shoulder arthroplasty) at a single institution from a single surgeon from April 2006 to April 2017. Distal peripheral neuropathy was defined for the study as symptoms or diagnostic testing consistent with cubital tunnel or carpal tunnel syndrome. Patients were excluded if they had known peripheral neuropathy or cervical radiculopathy prior to surgery. Patient demographics were reviewed including age, gender, laterality, prior shoulder surgery, and hand dominance. An analysis was performed to assess the onset of symptoms, conservative or operative treatments, resolution of symptoms, and complications.

Results

During this time period, 1387 arthroplasties were performed. 21 patients developed symptoms of ulnar or median neuritis and were further included in this study. This included 12 patients who underwent anatomic total shoulder and 9 patients who underwent reverse shoulder arthroplasty. There were 10 females and 11 males, the average age was 70 (±11) years. The overall incidence of peripheral neuropathy treated operatively was 1.5%. 12/21 patients developed symptoms of ulnar neuritis and 16/21 patients developed symptoms of median neuritis, thus 6 patients developed symptoms of both median and ulnar neuritis. Patients developed symptoms an average of 475 (±598) days after shoulder arthroplasty. 20/22 patients had an electromyography performed to confirm the presence of distal neuropathy. All patients underwent a trial of non-operative treatment. Ultimately, patients underwent an operative procedure an average of 666 (±565) days after shoulder arthroplasty. 13/21 patients reported complete resolution of their neuropathic symptoms after surgical treatment.

Discussion

This study retrospectively reviewed the incidence of peripheral neuropathy following shoulder arthroplasty. Overall, we found a 1.5% incidence of peripheral neuropathy requiring operative intervention. 62% of patients reported complete resolution of their symptoms after surgical treatment. Compressive peripheral neuropathy after shoulder arthroplasty may be under recognized. Although 62% had resolution after operative intervention, the average time to operative intervention was over 2 years. It may be that earlier definitive management could lead to better outcome. Further surveillance of this entity post-shoulder arthroplasty is warranted.