Lin Yenpo, Albers Marcio Bottene Villa, Fiore Jake, Williams Anna Bryn, Wimberly Audrey, Taylor Samuel A, Gulotta Lawrence V, Tan Ek T, Sneag Darryl B
Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Skeletal Radiol. 2025 May 13. doi: 10.1007/s00256-025-04946-x.
To characterize nerve injury patterns following total shoulder arthroplasty (TSA).
This retrospective study reviewed brachial plexus MR neurography (MRN) in patients with brachial plexopathy within 180 days post TSA from 2016 to 2023. Patients with pre-existing neurologic symptoms or without available electrodiagnostic testing (EDX) data were excluded. MRN findings were extracted from the original report and independently reviewed by a second, musculoskeletal fellowship trained radiologist.
A total of 27 patients (15F/12 M, mean age 67) were included. MRN and EDX-confirmed nerve injury localization matched in 13 patients, with nerve hyperintensity and/or enlargement identified in 7 cases at the plexus proper and 6 cases at the branch nerve level (suprascapular, axillary, radial, median). Nerve impingement by screw (n = 3) or extruded cement (n = 1) and mass effects including soft tissue edema (n = 1), hematoma (n = 2), or joint effusion (n = 2) were identified. MRN detected muscle denervation in 8 of 19 patients with EMG abnormalities, with a median TSA-to-MRN interval of 62.5 days (range, 19-95) versus 3 days (range, 2-155) in those without denervation on MRN (p = 0.003). Inter-rater reliability demonstrated substantial to almost perfect agreement for MRN assessments, except for cord hyperintensity. All patients were clinically followed up: 3 had complete symptomatic resolution and 21/27 reported partial improvement at a mean follow-up time of 25.5 months.
MRN findings closely correlated with EDX-confirmed clinical diagnoses in cases with MRN abnormalities. Additionally, MRN identified secondary findings, such as local mass effect on nerve segments, that can guide management.
描述全肩关节置换术（TSA）后神经损伤模式。
这项回顾性研究回顾了2016年至2023年TSA术后180天内患有臂丛神经病变患者的臂丛神经磁共振神经成像（MRN）。排除既往有神经症状或无可用电诊断测试（EDX）数据的患者。MRN结果从原始报告中提取，并由另一位接受过肌肉骨骼专科培训的放射科医生独立审查。
共纳入27例患者（15例女性/12例男性，平均年龄67岁）。13例患者的MRN和EDX确诊的神经损伤定位匹配，7例在臂丛神经本身、6例在分支神经水平（肩胛上神经、腋神经、桡神经、正中神经）发现神经高信号和/或增粗。发现螺钉压迫神经（n = 3）或骨水泥挤出压迫神经（n = 1）以及包括软组织水肿（n = 1）、血肿（n = 2）或关节积液（n = 2）在内的占位效应。19例肌电图异常患者中有8例通过MRN检测到肌肉失神经支配，TSA至MRN的中位间隔时间为62.5天（范围19 - 95天），而MRN未显示失神经支配的患者为3天（范围2 - 155天）（p = 0.003）。除了脊髓高信号外，评估者间信度显示MRN评估具有高度一致至几乎完全一致的结果。所有患者均进行了临床随访：3例症状完全缓解，27例中有21例在平均随访时间25.5个月时报告部分改善。
在有MRN异常的病例中，MRN结果与EDX确诊的临床诊断密切相关。此外，MRN还发现了继发性表现，如神经节段的局部占位效应，可指导治疗。
