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Peripheral Neuropathy Outside the Surgical Field after Shoulder Arthroscopy
Marta VF Mira, MD
1, Stella den Hengst, BSc
1, Anish Patel, BS
2, Evan A. O'Donnell, MD
1; Abhiram Bhashyam, MD
1(1)Massachusetts General Hospital, Boston, MA, (2)Boston University, Boston, MA
Introduction: Distal peripheral neuropathies (DPNs) are recognized complications of shoulder arthroscopy (SA), potentially leading to permanent sensory and motor nerve deficits. DPNs outside the surgical field are rare but possibly underreported. Given the growing use of SA, the incidence of these injuries may increase. This study aims to determine the incidence and identify risk factors of DPNs outside the surgical field after SA.
Materials & Methods: Patients 18 years and older who underwent SA were identified and divided into two groups. The case group (secondary nerve compression) included patients who developed ipsilateral upper extremity DPNs outside the surgical field within 12 months of the initial SA. The control group (no nerve decompression) included patient who did not undergo secondary nerve decompression following SA. Patient, diagnosis, and treatment characteristics were collected and analyzed. Multivariable binary logistic regression with ridge regression was performed to identify risk factors.
Results: Out of 11,850 patients who got SA, 30 (0.25%) patients were included in the secondary nerve decompression group, with a mean age of 58 years (SD ± 12.2) and 66.7% being male. The mean time from SA to DPN diagnosis was 4.83 months (SD 3.81), with decompression performed at a mean of 1.67 months (SD 2.92) after diagnosis. Median nerve neuropathy was most common (56.7%), followed by the ulnar nerve (36.7%). Ridge regression identified preoperative nerve symptoms (coefficient=3.042, OR=20.956), the McConnell arm holder (coefficient=2.830, OR=16.952), the Spider arm holder (coefficient=0.908, OR=2.480) and labor-intensive jobs (coefficient=1.167, OR=3.213) as significant predictors. At the final follow-up, 63.3% neuropathies had resolved, 26.7% partially improved, and 10% showed no improvement.
Conclusions: DPNs outside the surgical field following SA were identified in a small number of patients, with the median nerve most affected. Although most patients experienced symptom resolution, 36.7% saw partial or no recovery. Earlier recognition and timely referral for management are critical to optimizing recovery and long-term function. In patients with preoperative nerve symptoms and/or labor-intensive jobs, avoiding the McConnell and Spider arm holder, providing preoperative counseling, and ensuring close postoperative monitoring may improve outcomes.
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