Introduction
Materials and methods
Article | Number of patients | Mean patient age (age range) | Sex male/female | Side right/left | Cause of initial trauma | Associated injuries | Nerve injury | Operation |
---|---|---|---|---|---|---|---|---|
Robinson et al. [5] | 492 out of 3633 (13.5%) | All patients 47.6 (13–104) BPI 42.5 BPI + GTF/RCT 57.5 BPI + GTF 56.3 BPI + RCT 63.0 All patients with nerve injury 51.5 years | All 1.6:1 BPI 2:1 BPI + GTF/RCT 1:1 BPI + GTF 0.9:1 BPI + RCT 1.2:1 All patients with nerve injury 1.3:1 | All patients 54.2%:45.8% | Order: BPI–BPI + GTF/RCT–BPI + GTF–BPI + RCT–all–all with nerve injury Fall = 40.5%; 68.4%; 68%; 69.7%; 49.8%; 56.5% Fall from height = 11%; 12.1%; 13.1%; 9.2%; 10.3%; 11.6% Sports injury = 42.4%; 7.1%; 8.3%: 3.9%; 34%; 22.2% MVA = 4.8%; 6.4%; 5.8%; 7.9%; 3.6%; 5.7% Other = 1.4%; 6%; 4.9%; 9.2%; 2.4%; 4.1% | BPI + RCT/GTF 282 pts (7.8%) BPI + GTF 206 pts (5.7%) BPI + RCT 76 pts (2.1%) | BPI alone 210 pts (5.8%) BPI alone–BPI + GTF–BPI + RCT–all Axillary = 73.8%; 62.6%; 59.2%; 66.9% Ulnar = 10.5%; 11.2%; 9.2%; 10.6% Radial = 1.4%; 2.4%; 1.3%; 1.8% MSC = 1%; 1%; 2.6%; 1.2% Median = 3.8%; 1.9%; 2.6%; 2.8% Multiple = 9.5%; 20.9%; 25%; 16.7% | 3 patients (tendon transfers) |
Travlos et al. [6] | 28 | 42.6 (17–82) | 19:9 | – | Minor fall 9; major fall 6; MVA 7; Direct blow 3; Other 3 | GTF (2), clavicle frx (1), scapula frx (3), clavicle + scapula frx (1) | Infraclavicular + supraclavicular 8; diffuse infraclavicular 7; axillary 7; axillary + lateral cord 2; posterior + medial cord 1; medial cord 3 | 5 operated-on: 4 neurolysis; 3 grafts (axillary nerve) |
Wehbe et al. [7] | 33 (10 GHD) | 30 (13–70) | 26:7 | 15:18 | MVA 19; sports accident 2; occupational injury 2; fall 6; automobile crash 2; positional anomaly 1; direct blow 1; extreme abduction 9; anterior GHD 10; unclear 13 | Present 23: ACD 3; GTF 3; fractures: scapula 5; humerus 2; forearm 2; rib 3; clavicle 3 | Axillary only 16 Axillary + suprascapular 5 Axillary + infraclavicular BPI 11 Axillary + supraclavicular BPI 1 | All (20 nerve grafting; 13 neurolysis) |
Liveson [8] | 11 | 55 (28–76) | 8:3 | – | Fall 6; motorcycle accident 1; traction 2; recurrent GHD 1; blunt blow 1 | 3 factures non-specified | Axillary only 3; MSC 1 Axillary + radial + MSC + median 1 Medial cord (+posterior) 1 Posterior cord 1 Brachial plexus + suprascapular 1 Axillary + MSC 2 Axillary + branch to triceps 1 (axillary 10; MSC 5) | No |
Kosiyatrakul et al. [9] | 14 (15 shoulders) | 47.8 (27–83) | 9:5 | 7:6:1B | Fall 5; fall from height 1; car accident 3; motor accident 3; skiing accident 1; lifting 1 | GTF 6 | 3 suprascapular nerve Recovery 20 months (thenar, interossei worst recovery) | 3 patients (tendon transfers) |
Toolanen et al. [10] | 65 pts (36 nerve injuries) | 64 (41–90) | 36:29 | 39:26 | – | RCT 24 (terrible triad 12) | Axillary only 30; axillary + other 5; radial ( +median + ulnar) 1 | No |
deLaat et al. [11] | 101 (44 GHD) 14 nerve lesions | 53 for GHD patients | 30:71 | 47:54 | Fall 87; sports accident 14 | In GHD group: GTF 7; RCT 3 | Axillary only 8; axillary + other 18; axillary 37 pts; radial 22 pts MSC 19 pts; ulnar 8 pts | No |
Yeap et al. [12] | 11 (out of 115 pts; 80 GHD) | 35.7 | 8:3 | – | 7 fall; 2 MVA; 2 spontaneous | – | Axillary only 5, ulnar 2, median 1, diffuse BPI 1; axillary + radial 1; axillary + radial + ulnar 1 | No |
Pasila et al. [13] | 50 (out of 238) | Most pts > 50 years | All 133:105; Complicated 34:29 | – | Fall 22; fall from height 7; twist 10 | RCT 28 | 21 axillary; 29 multiple | No |
Pasila et al. [14] | 44 (out of 226) | Most > 50 years | All 126:100 | – | Fall 92; fall from height 15; torsion 24 | 26 RCT; terrible triad 6 | 19 axillary (6 persistent), 25 multiple (9 persistent) | No |
Visser et al. [15] | 37 (out of 77) | 52.3 (16–94) | All 38:39 BPI 15:22 | 42:35 | – | GTF 12 (BPI + GTF 10) RCT 7 | Axillary 32; radial 5; MSC 9; median 3, ulnar 6; complete 1, single nerve injury 51% | No |
Visser et al. [16] | 215 pts 74 GHD 133 nerve injuries | 64.2 (12–94) | 58:157 | – | – | – | Nerve injury in 50% of GHDs (37) Axillary – 53%; Radial-24%; MSC 24%; median 12%; ulnar 7% 30% single nerve injury; posterior cord 38% | No |
Payne et al. [17] | 48 (2.6% out of 1844) | 45.5 (15–80) Terrible triad = 4/5 pts > 57 years of age | 33:15 4:1 (triad) | 3:2 (triad) | Fall 17; MVA 14; lifting 7 | Unhappy triad 5 pts (10.4%); 2× axillary; 3× multiple nerve injury | Total BPI-20 pts; Mononeuropathy 17 pts (axillary 47%, MSC 6%) multiple nerves 11 pts (axillary + MSC 45%; axillary + suprascap. 36%) Triad: 2× axillary; 2× axillary + suprasc.; 2× axillary + MSC | No |
Hems and Mahmood [18] | 101 pts 55 GHD | Whole group 46 (14–89); BPI 52 (16–86) | 62:39 32:23 | – | Fall 37, fall from height 6, MVA 5, skiing 3, assault 2, fall from a horse 2 | RCT/GTF 17 (31%) 1 false aneurysm | Complete 14; axillary 37; ulnar 39; median 35; radial 28; MSC 28; axillary rupture 3.6% (2 pts) median, ulnar worst recovery | 8 operated (15%) |
Gutkowska et al. [19] | 73 | Mean 50 | 58:15 | 40:33 | Fall 37, fall from height 21, MVA 7, other 8 | GTF 22, RCT 7, HF 4 | Axillary 54, ulnar 51, median 48, radial 45, MCS 21 | All operated |
Strafun et al. [20] | 25 (20.8% of 120 GHDs) | 51.52 ± 12.97 (27–66) | 18:7 | 13:12 | – | 17 RCT (16 operated-on) 8 GTF | Axillary nerve 15 Diffuse BPI 10 | Operated: axillary 2; BP neurolysis 4 |
Fox et al. [21] | 22 | Mean 53 | 19:3 | – | – | 13 RCT (7 oper.) 9 GTF (7 oper.) | Mononeuropathy 4, axillary 20, MSC 6 (cords: posterior 10; medial 8; lateral 7) | All BPIs (grafting 5) |
Atef et al. [22] | 240 | All 35.2 (20–60) only Axillary 46.3 Axil. + GTF 32.8 Axil. + RCT 53.9 | 176:64 | 216 domin:24 non-domin. | Fall 43.3%; fall from height 23.3%; trauma 20.8%, MVA 12.5% (incl. all axillary + GTF); triad–fall on outstretched hand | Axillary + RCT 6.25% (15 pts) Axillary + GTF 6.25% | Only axillary Axillary 38 pts (15.6%) Axillary alone 3.33% (8 pts) Triad age > 48 years in all pts | No |
Perron et al. [23] | 24 (out of 190) | 34.3 for all pts | 78%:22% (all pts) | 48%:52% (all pts) | – | 10 GTF | All axillary 75% went off after reduction | No |
Gumina and Postacchini [24] | 545 GHD | Elderly | – | – | – | RCT 61% | Axillary 9.3% Spontan. recovery in 3–12 months | No |
Vermeiren et al. [25] | 154 GHD (4 BPIs) | – | – | – | – | – | Axillary 1 Radial + ulnar 3 | No |
Saragaglia et al. [26] | 233 GHD | – | – | – | – | – | 10 (6 axillary, 4 combined) | No |
teSlaa et al. [27] | 105 pts 107 shoulders | 42 Whole group 39 | – | 55:52 | 34% sport; 28% home | – | 22 nerve injuries Axillary 13 | No |
Lill et al. [28] | 175 GHD | – | – | – | – | – | 6 nerves: axillary 4, radial 2 | No |
Neviaser et al. [29] | 31 | Mean 57.5 | 22:9 | – | – | RCT 100% | Axillary 4 | All RCTs operated |
Sturm and Perry [30] | 59 (6 GHD) | 35.5 (2–84) | 45:14 | 23:33:3B | MVA 53% | – | Complete BPI 8 | No |
Leffert and Seddon [31] | 31 pts (17 GHD) | Median age 27 | 27:4 | – | Fall 7; fall from vehicle 12, struck by car 2, MVA 4, blow 3; hyperabduction 3 | 12 GTF; 1 scapula fracture | Diffuse BPI 14 | 4 operated |
Bumbasirevic et al. [32] | 18 | (17 > 40 years) | – | – | – | – | 50% nerve injury: axillary 38,3%; MSC 22% | No |
Article | Sex | Side | Cause of injury | Associated injuries | Nerve injury | Age | Operative treatment |
---|---|---|---|---|---|---|---|
Dhar [33] | F | R | MVA | – | Diffuse | 32 | No |
Jerosch et al. [34] | M | – | – | – | MSC | 47 | – |
Saab [35] | F | R | Fall from a horse | – | Diffuse | 49 | No |
Koulali-Idrissi et al. [36] | M | R | Fall | GTF | Total BPI | 52 | No |
Volpin et al. [37] | F | R | Fall from stairs | – | Total | 62 | Recovery in 9 months |
Volpin et al. [37] | F | R | Fall from stairs | – | Total (ulnar nerve slowest to recover) | 52 | Recovery in 12 months |
Ameh and Crane [38] | F | R | Fall | no | Radial + ulnar | 57 | No |
Chillemi et al. [39] | M | L | MVA | GTF | Posterior cord | 27 | No |
Sinha et al. [40] | M | R | Fall | – | Posterior + medial cord | 71 | No |
Shears et al. [41] | M | L | Fall | GTF | Posterior + medial cord | 32 | No |
Rathore et al. [42] | F | R | Fall from stairs | Proximal humerus fracture (oper.) | Median + radial | 53 | Good recovery in 3 months |
Incidence
Mechanism of nerve injury
Affection of particular nerves
Severity of lesions
Risk factors for neurological complications
Accompanying injuries
Rotator cuff tear/fracture of the greater tuberosity of humerus
Author, year | Age | Sex | Side | Mechanism | Injury | Treatment | Outcome |
---|---|---|---|---|---|---|---|
Goubier et al., 2003 [83] | 27 | M | L | Motorcycle accident | Supraspinatus, infraspinatus Retroclavicular BP palsy; GTF | RCT–oper. BPI–conserv. | Full recovery of diffuse BPI in 12 months |
Gonzales and Lopez, 1991 [79] | 57 | F | R | Assaulted | Full thickness RCT Axillary, MSC | RCT–oper. BPI–conserv. | Resolution of symptoms in 3 months |
Gonzales and Lopez, 1991 [79] | 66 | M | L | Struck by a car | GTF, medial cord (complete), lateral cord (incomplete) | Conservative | Lateral cord—complete recovery in 2 years; medial cord—no recovery |
Groh and Rockwood, 1995 [81] | 57 | F | R | Fall | Full thickness RTC Axillary n., incomplete | Conservative | Complete recovery in 6 months |
Groh and Rockwood, 1995 [81] | 41 | M | R | Motorcycle accident | Full thickness RTC Axillary n., incomplete | RCT–oper. BPI–conserv. | Complete recovery in 3 months |
Güven et al. 1994 [80] | 53 | M | L | Struck by a car | RCT; total BPI | RCT–oper. BPI–conserv. | Spontan. recovery in 3 months |
Miller et al., 2012 [84] | 42 | M | R | Fall from 10 m | RCT; axillary nerve | RCT – oper. BPI–conserv. | Recovery in 6 months |
Simonich and Wright, 2003 [70] | Mean 57 (37–79) | 5 M + 1 F | 3R 3 L | – | Full thickness RTC 5 axillary; 1 axillary + 1 SSC | RCT–oper. 1 axillary–oper. SSC–oper. | 5/6 BPI–recovery in 12 months; 1 axillary (oper. after 10 months)-persistent palsy |
Takase et al., 2014 [66] | 61 | F | R | Fall | RTC + axillary n. + glenoid rim frx (terrible tetrad) | RCT–oper. | Nerve recovery, 3 months |
Mehta and Kottamasu, 1989 [85] | 53 | M | R + L | Fall | RCT (R) + diffuse BPI (R) | Conservative | Gradual recovery |
Brown et al., 2000 [67] | Mean 65 | 6 M + 9 F | – | – | 12 axillary + 4SSC + 1MSC | 13 RCT–oper. | Nerve recovery: 8 complete 7 incomplete |
Rovesta et al., 2015 [51] | 47 (21–72) | 24 pts 21 M + 3 F | – | 17 high-energy 7 low-energy | Axillary, all (18, as a single nerve) | 7 conservative 10 neurolysis 7 grafting | Nerve recovery: 8 good 10 medium 6 bad |
Prudnikov 1994 [69] | – | 22 pts (20 GHD) | – | – | Axillary, all | All RCT–oper. | 4 persistent palsy |
Johnson and Bayley, 1982 [82] | 51 (31–76) | 12 pts 9 M + 3 F | – | – | Axillary, all 4 axillary + other nerve | 5 RCT, 7 GTF 9–oper. | 2 good 3 fair 4 poor |
Neurovascular injury
Author, year | Age | Sex | Side | Mechanism | Vascular injury | Nerve injury | Recovery |
---|---|---|---|---|---|---|---|
Allie 2005 et al., [88] | 60 | M | L | Fall | Axillary artery | Below C5 level | ivr; good recovery after 6 weeks |
Nikolaou et al., 2008 [89] | 74 | M | L | Fall | Axillary artery | Median, ulnar, radial | ivr Recovery in 12 months |
Helm and Watson, 2002 [63] | 68 | M | L | Lifting, fall, bilateral, recurrent GHD | Axillary artery pseudoaneurysm | Total BPI | pvr after 5 months + brachial plexus neurolysis; injury persistent at 9 months |
Razif and Ramalingam, 2002 [61] | 25 | M | L | MVA | Axillary artery | Axillary | ivr Improvement after 6 months |
Mullett et al., 1998 [90] | 62 | M | R | Fall | Axillary artery | Diffuse | ivr Partial recovery at 9 months |
Emadian 1996 [62] | 83 | Fb | R | Fall | Axillary artery pseudoaneurysm | Axillary | pvr NDA |
Mwipatayi et al., 2005 [91] | 37 | M | R | Knee-boarding | Axillary artery pseudoaneurysm | Total BPI | ivr + brachial plexus neurolysis NDA |
Regauer et al., 2014 [4] | 69 | M | R | Hippocrates reduction | Brachial vein | Diffuse | ivr + brachial plexus neurolysis Recovery in 6 months |
Murata et al., 2008 [58] | 16 | M | R | MVA | Axillary artery | Good | Neurolysis on the 3rd day; good result |
Nash et al., 1984 [59] | 76 | M | L | Hippocrates reduction | Subscapular artery | Median | ivr Partial recovery after 6 months |
Curley et al., 1988 [92] | 17 | F | L | Simple reduction of recurrent GHD | Subclavian artery | Total BPI | Ehler-Danlos syndrome arm amputation |
Shaw et al., 1995 [93] | 3 patients | – | – | – | Axillary artery | Diffuse | Recovery poor in 2 patients, good in 1 patient |
Stenning et al., 2005 [54] | Mean 67 range 43–88 | 20 patients (16 GHDs) | – | Low-energy injuries | Axillary artery | Median 20, ulnar 19, radial 19, MSC 17, axillary 12 | irv/pvr + brachial plexus neurolysis Bad result in 1 median, 1 axillary nerve |