Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, , 5º Planta, Ala Sur. Calle Profesor Martín Lagos S/N, 28004, Madrid, Spain.
Department of Surgery, Complutense University, Madrid, Spain.
Int Orthop. 2024 May;48(5):1285-1294. doi: 10.1007/s00264-024-06130-7. Epub 2024 Mar 13.
Prevalence of axillary (AN) and/or suprascapular (SSN) neuropathy in rotator cuff tear arthropathy (RCTA) is unknown. We aimed to prospectively evaluate for preoperative neurodiagnostic abnormalities in order to determine their prevalence, location, and influence on reverse shoulder arthroplasty (RSA) outcomes.
Patients who underwent RSA for RCTA were prospectively included. An electromyography and nerve conduction study were performed pre and post-surgery. Clinical situation: VAS, Relative Constant-Murley Score (rCMS) and ROM over a minimum of two years follow-up.
Forty patients met the inclusion criteria; mean follow-up was 28.4 months (SD 4.4). Injuries in RCTA were present in 83.9% (77.4% in AN and 45.2% in SSN). There were no differences on preoperative VAS, ROM, and rCMS between patients with and without preoperative nerve injuries. Four acute postoperative neurological injuries were registered under chronic preoperative injuries. Six months after RSA, 69% of preoperative neuropathies had improved (82.14% chronic injuries and 77.7% disuse injuries). No differences in improvement between disuse and chronic injuries were found, but patients with preoperative neuropathy that had not improved at the postoperative electromyographic study at six months, scored worse on the VAS (1.44 vs 2.66; p .14) and rCMS (91.6 vs 89.04; p .27).
The frequency of axillary and suprascapular neuropathies in RCTA is much higher than expected. Most of these injuries improve after surgery, with almost complete neurophysiological recovery and little functional impact on RSA. However, those patients with preoperative neuropathies and absence of neurophysiological improvement six months after surgery have lower functional results.
肩袖撕裂性关节炎（RCTA）患者腋部（AN）和/或肩胛上（SSN）神经病的患病率尚不清楚。我们旨在前瞻性评估术前神经诊断异常，以确定其患病率、位置及其对反肩关节置换术（RSA）结果的影响。
前瞻性纳入接受 RSA 治疗 RCTA 的患者。术前和术后均进行肌电图和神经传导研究。临床情况：VAS、相对恒定-默尔利评分（rCMS）和 ROM，随访至少 2 年。
40 名患者符合纳入标准；平均随访时间为 28.4 个月（SD 4.4）。RCTA 中的损伤分别出现在 83.9%（77.4%在 AN 中，45.2%在 SSN 中）。术前 VAS、ROM 和 rCMS 无差异，两组患者术前均有神经损伤。在慢性术前损伤下，4 例患者在术后出现急性神经损伤。RSA 后 6 个月，69%的术前神经病变得到改善（82.14%慢性损伤和 77.7%废用性损伤）。在改善方面，废用性和慢性损伤之间没有差异，但在术后 6 个月肌电图研究中，术前神经病变未改善的患者，VAS 评分（1.44 分比 2.66 分；p ＜.01）和 rCMS（91.6 分比 89.04 分；p ＜.01）更差。
RCTA 腋部和肩胛上神经病的发生率远高于预期。大多数这些损伤在手术后得到改善，神经生理学恢复几乎完全，对 RSA 的功能影响很小。然而，那些术前有神经病变且术后 6 个月神经生理学无改善的患者，其功能结果较低。
