Shields Lisa B E, Iyer Vasudeva G, Zhang Yi Ping, Shields Christopher B
Norton Neuroscience Institute, Norton Healthcare, Louisville 40202, Kentucky, USA.
Neurodiagnostic Center of Louisville, Louisville 40245, Kentucky, USA.
Case Rep Neurol Med. 2025 Jun 19;2025:9969463. doi: 10.1155/crnm/9969463. eCollection 2025.
Gorham-Stout disease (GSD), also known as vanishing bone disease or massive osteolysis, is a rare entity characterized by destruction of the osseous matrix and proliferation of vascular structures resulting in bone resorption. While neurological complications such as cerebrospinal rhinorrhea secondary to cranial involvement and paraplegia from spinal involvement have been reported, peripheral nerve complications are not known. We describe a case of radial nerve palsy that was an iatrogenic complication of shoulder replacement surgery with bone loss of the humerus resembling GSD. A 71-year-old male with a history of left total shoulder arthroplasty followed by a revision reverse total shoulder arthroplasty noted a "bone protruding" and pain in the left upper arm 12 years later. X-rays showed that the proximal portion of the humerus was not detectable. CT scan of the left upper extremity revealed loosening of the humeral component with prominent osteolysis most pronounced around the distal stem. The patient underwent a revision of the reverse total shoulder arthroplasty with replacement of the humeral head and shaft. He experienced numbness, pain, and weakness of the left shoulder and arm with wrist drop postoperatively. Physical exam revealed marked weakness of the dorsiflexors of the wrist and digits, wasting and weakness of the brachioradialis muscle, and loss of pinprick sensation of the superficial radial nerve distribution. Needle EMG showed denervation changes in the extensor digitorum communis, brachioradialis, and extensor carpi radialis longus muscles. An ultrasound (US) study showed enlargement of the left radial nerve at the spiral groove. The EDX and US findings suggested a left radial nerve palsy at the spiral groove. There were minimal EMG abnormalities in the deltoid and triceps muscles suggesting additional involvement of the posterior cord of the brachial plexus. This case illustrates the potential for iatrogenic radial nerve palsy following shoulder replacement surgery with significant bone loss of the humerus resembling GSD.
戈勒姆-斯托特病（GSD），也被称为骨质消失病或大块骨质溶解症，是一种罕见病症，其特征为骨基质破坏和血管结构增殖导致骨质吸收。虽然已有报道称存在神经系统并发症，如颅骨受累继发的脑脊液鼻漏以及脊柱受累导致的截瘫，但周围神经并发症尚不清楚。我们描述了一例桡神经麻痹病例，它是肩关节置换手术的医源性并发症，伴有肱骨骨质流失，类似于戈勒姆-斯托特病。一名71岁男性，有左全肩关节置换术病史，随后进行了翻修反向全肩关节置换术，12年后他注意到左上肢有“骨头突出”和疼痛。X线显示肱骨近端无法检测到。左上肢CT扫描显示肱骨假体松动，骨溶解明显，最明显的部位在远端柄周围。患者接受了翻修反向全肩关节置换术，更换了肱骨头和骨干。术后他出现了左肩和手臂麻木、疼痛、无力以及垂腕。体格检查显示腕关节和手指背伸肌明显无力，肱桡肌萎缩和无力，以及桡神经浅支分布区域针刺感觉丧失。针极肌电图显示指总伸肌、肱桡肌和桡侧腕长伸肌有失神经改变。超声（US）检查显示螺旋沟处左桡神经增粗。肌电图和超声检查结果提示螺旋沟处左桡神经麻痹。三角肌和肱三头肌的肌电图异常轻微，提示臂丛后束也有额外受累。该病例说明了在肱骨出现类似戈勒姆-斯托特病的大量骨质流失的肩关节置换手术后发生医源性桡神经麻痹 的可能性。
