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LeBrun DG, Sneag DB, Feinberg JH, et al. Surgical Treatment of Iatrogenic Nerve Injury Following Arthroscopic Capsulolabral Repair. J Hand Surg Am. 2021;46(12):1121.e1-1121.e11doi: 10.1016/j.jhsa.2021.03.006.
LeBrun, D. G., Sneag, D. B., Feinberg, J. H., McCarthy, M. M., Gulotta, L. V., Lee, S. K., & Wolfe, S. W. (2021). Surgical Treatment of Iatrogenic Nerve Injury Following Arthroscopic Capsulolabral Repair. The Journal of hand surgery, 46(12), 1121.e1-1121.e11. https://doi.org/10.1016/j.jhsa.2021.03.006
LeBrun, Drake G, et al. "Surgical Treatment of Iatrogenic Nerve Injury Following Arthroscopic Capsulolabral Repair." The Journal of hand surgery vol. 46,12 (2021): 1121.e1-1121.e11. doi: https://doi.org/10.1016/j.jhsa.2021.03.006
LeBrun DG, Sneag DB, Feinberg JH, McCarthy MM, Gulotta LV, Lee SK, Wolfe SW. Surgical Treatment of Iatrogenic Nerve Injury Following Arthroscopic Capsulolabral Repair. J Hand Surg Am. 2021 Dec;46(12):1121.e1-1121.e11. doi: 10.1016/j.jhsa.2021.03.006. Epub 2021 Apr 24. PMID: 33902974.
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J Hand Surg Am. 2021 Dec;46(12):1121.e1-1121.e11. doi: 10.1016/j.jhsa.2021.03.006. Epub 2021 Apr 24.

Surgical Treatment of Iatrogenic Nerve Injury Following Arthroscopic Capsulolabral Repair.

The Journal of hand surgery

Drake G LeBrun, Darryl B Sneag, Joseph H Feinberg, Moira M McCarthy, Lawrence V Gulotta, Steve K Lee, Scott W Wolfe

Affiliations

  1. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY. Electronic address: [email protected].
  2. Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY.
  3. Department of Physiatry, Hospital for Special Surgery, New York, NY.
  4. Department of Orthopedic Surgery, Sports Medicine, Hospital for Special Surgery, New York, NY.
  5. Department of Orthopedic Surgery, Hand and Upper Extremity, Hospital for Special Surgery, New York, NY.

PMID: 33902974 DOI: 10.1016/j.jhsa.2021.03.006

Abstract

PURPOSE: Case reports of nerve injuries following arthroscopic capsulolabral repair emphasize the proximity of major nerves to the glenoid. This study describes preoperative localization using nerve-sensitive magnetic resonance imaging in a small cohort of patients with iatrogenic nerve injuries following arthroscopic capsulolabral repair and the outcomes of nerve repair in these patients.

METHODS: Cases of iatrogenic nerve injury following arthroscopic capsulolabral repair referred to 2 surgeons from January 2017 to December 2019 were identified. Clinical charts, electrodiagnostic testing, magnetic resonance imaging studies, and operative reports were reviewed.

RESULTS: Four cases of iatrogenic nerve injury were identified. The time to presentation to our institution ranged from 2 weeks to 8 years. The axillary nerves in 3 cases were tethered by a suture at the inferior glenoid, whereas 1 case had a suture tied around the radial and median nerves inferior to the glenohumeral joint capsule. One case underwent excision and nerve transfer, 1 underwent excision and nerve repair, and 2 underwent suture removal and neurolysis. Open and arthroscopic approaches, including a recently described approach to the axillary nerve in the "blind zone," were used. Three cases demonstrated good recovery of all affected motor and sensory functions after surgery. At the 10-month follow-up, 1 case had persistent weakness, but there was evidence of axonal regeneration on electrodiagnostic testing.

CONCLUSIONS: Arthroscopic capsulolabral repair places regional nerves, particularly the axillary nerve, at risk owing to their proximity to the joint capsule and inferior glenoid. Patients with neuropathic pain in the distribution of affected nerves with corresponding sensorimotor loss following arthroscopic capsulolabral surgery should undergo focused magnetic resonance imaging with nerve-sensitive sequences and electrodiagnostic testing to localize the injury. The use of multiple surgical windows to the axillary nerve in the "blind zone" enables full visualization for neurolysis, suture removal, and nerve repair or transfer.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.

Copyright © 2021 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Keywords: Axillary nerve; HAGL; MRI; brachial plexus; capsulolabral repair

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