[DIAGNOSIS AND TREATMENT OF ROTATOR CUFF TEAR AND BRACHIAL PLEXUS INJURY].

OBJECTIVE

To investigate the mechanisms, diagnosis, and surgical procedures of simultaneous lesions of the rotator cuff and the brachial plexus.

METHODS

Between July 2006 and June 2012, 7 patients with rotator cuff tear associated with brachial plexus injury were treated. There were 3 males and 4 females with a mean age of 47.3 years (range, 37-72 years). The reasons of injury were traumatic shoulder dislocation in 6 cases and falling injury from height in 1 case, with a mean disease duration of 17 days (range, 5-31 days). The average American Shoulder and Elbow Surgeons (ASES) score was 55.86 ± 9.42, and visual analogue scale (VAS) score was 7.14 ± 1.35. There were 3 cases of large rotator cuff tears (> 3 cm) and 4 cases of massive rotator cuff tears (> 5 cm) according to Gerber standard; 1 case had upper trunk injury of the brachial plexus and 6 cases had bundle branch injury of the brachial plexus according to GU Yudong's classification. The functional score of brachial plexus score was 7.43 ± 1.27 according to the functional assessment standard by Hand Surgery Branch of Chinese Medical Association. All patients accepted arthroscopic rotator cuff repairing, and 1 case received surgical neurolysis of brachial plexus.

RESULTS

All incisions healed by first intention without complication. All the 7 patients were followed up 18 to 25 months (mean, 20.4 months). The function, muscle strength, and sensation of the shoulder were improved obviously. The shoulder ASES score was 84.71 ± 8.06 and was significantly better than preoperative score (t = -8.194, P = 0.000). The VAS score was 2.71 ± 1.50 and was significantly better than preoperative score (t=7.750, P=0.000). The functional score of brachial plexus was 14.00 ±1.16 and was significantly better than preoperative score (t = -11.500, P = 0.000).

CONCLUSION

It is difficult to simultaneously diagnose lesions of the rotator cuff and the brachial plexus; orthopedists should pay attention to possible patients to avoid missed diagnosis and diagnostic errors. Nerve nutrition, physical therapy, and arthroscopic rotator cuff repair can achieve good effectiveness.