Table 1.
Literature source file—articles reporting neurological complications of shoulder dislocation
| Article | Number of patients | Mean patient age (age range) | Sex male/female | Side right/left | Cause of initial trauma | Associated injuries | Nerve injury | Operation |
|---|---|---|---|---|---|---|---|---|
| Robinson et al. [5] | 492 out of 3633 (13.5%) |
All patients 47.6 (13–104) BPI 42.5 BPI + GTF/RCT 57.5 BPI + GTF 56.3 BPI + RCT 63.0 All patients with nerve injury 51.5 years |
All 1.6:1 BPI 2:1 BPI + GTF/RCT 1:1 BPI + GTF 0.9:1 BPI + RCT 1.2:1 All patients with nerve injury 1.3:1 |
All patients 54.2%:45.8% |
Order: BPI–BPI + GTF/RCT–BPI + GTF–BPI + RCT–all–all with nerve injury Fall = 40.5%; 68.4%; 68%; 69.7%; 49.8%; 56.5% Fall from height = 11%; 12.1%; 13.1%; 9.2%; 10.3%; 11.6% Sports injury = 42.4%; 7.1%; 8.3%: 3.9%; 34%; 22.2% MVA = 4.8%; 6.4%; 5.8%; 7.9%; 3.6%; 5.7% Other = 1.4%; 6%; 4.9%; 9.2%; 2.4%; 4.1% |
BPI + RCT/GTF 282 pts (7.8%) BPI + GTF 206 pts (5.7%) BPI + RCT 76 pts (2.1%) |
BPI alone 210 pts (5.8%) BPI alone–BPI + GTF–BPI + RCT–all Axillary = 73.8%; 62.6%; 59.2%; 66.9% Ulnar = 10.5%; 11.2%; 9.2%; 10.6% Radial = 1.4%; 2.4%; 1.3%; 1.8% MSC = 1%; 1%; 2.6%; 1.2% Median = 3.8%; 1.9%; 2.6%; 2.8% Multiple = 9.5%; 20.9%; 25%; 16.7% |
3 patients (tendon transfers) |
| Travlos et al. [6] | 28 | 42.6 (17–82) | 19:9 | – | Minor fall 9; major fall 6; MVA 7; Direct blow 3; Other 3 | GTF (2), clavicle frx (1), scapula frx (3), clavicle + scapula frx (1) | Infraclavicular + supraclavicular 8; diffuse infraclavicular 7; axillary 7; axillary + lateral cord 2; posterior + medial cord 1; medial cord 3 | 5 operated-on: 4 neurolysis; 3 grafts (axillary nerve) |
| Wehbe et al. [7] | 33 (10 GHD) | 30 (13–70) | 26:7 | 15:18 | MVA 19; sports accident 2; occupational injury 2; fall 6; automobile crash 2; positional anomaly 1; direct blow 1; extreme abduction 9; anterior GHD 10; unclear 13 | Present 23: ACD 3; GTF 3; fractures: scapula 5; humerus 2; forearm 2; rib 3; clavicle 3 |
Axillary only 16 Axillary + suprascapular 5 Axillary + infraclavicular BPI 11 Axillary + supraclavicular BPI 1 |
All (20 nerve grafting; 13 neurolysis) |
| Liveson [8] | 11 | 55 (28–76) | 8:3 | – | Fall 6; motorcycle accident 1; traction 2; recurrent GHD 1; blunt blow 1 | 3 factures non-specified |
Axillary only 3; MSC 1 Axillary + radial + MSC + median 1 Medial cord (+posterior) 1 Posterior cord 1 Brachial plexus + suprascapular 1 Axillary + MSC 2 Axillary + branch to triceps 1 (axillary 10; MSC 5) |
No |
| Kosiyatrakul et al. [9] | 14 (15 shoulders) | 47.8 (27–83) | 9:5 | 7:6:1B | Fall 5; fall from height 1; car accident 3; motor accident 3; skiing accident 1; lifting 1 | GTF 6 |
3 suprascapular nerve Recovery 20 months (thenar, interossei worst recovery) |
3 patients (tendon transfers) |
| Toolanen et al. [10] | 65 pts (36 nerve injuries) | 64 (41–90) | 36:29 | 39:26 | – | RCT 24 (terrible triad 12) | Axillary only 30; axillary + other 5; radial ( +median + ulnar) 1 | No |
| deLaat et al. [11] |
101 (44 GHD) 14 nerve lesions |
53 for GHD patients | 30:71 | 47:54 | Fall 87; sports accident 14 | In GHD group: GTF 7; RCT 3 |
Axillary only 8; axillary + other 18; axillary 37 pts; radial 22 pts MSC 19 pts; ulnar 8 pts |
No |
| Yeap et al. [12] | 11 (out of 115 pts; 80 GHD) | 35.7 | 8:3 | – | 7 fall; 2 MVA; 2 spontaneous | – | Axillary only 5, ulnar 2, median 1, diffuse BPI 1; axillary + radial 1; axillary + radial + ulnar 1 | No |
| Pasila et al. [13] | 50 (out of 238) | Most pts > 50 years | All 133:105; Complicated 34:29 | – | Fall 22; fall from height 7; twist 10 | RCT 28 | 21 axillary; 29 multiple | No |
| Pasila et al. [14] | 44 (out of 226) | Most > 50 years | All 126:100 | – | Fall 92; fall from height 15; torsion 24 | 26 RCT; terrible triad 6 | 19 axillary (6 persistent), 25 multiple (9 persistent) | No |
| Visser et al. [15] | 37 (out of 77) | 52.3 (16–94) |
All 38:39 BPI 15:22 |
42:35 | – |
GTF 12 (BPI + GTF 10) RCT 7 |
Axillary 32; radial 5; MSC 9; median 3, ulnar 6; complete 1, single nerve injury 51% | No |
| Visser et al. [16] |
215 pts 74 GHD 133 nerve injuries |
64.2 (12–94) | 58:157 | – | – | – |
Nerve injury in 50% of GHDs (37) Axillary – 53%; Radial-24%; MSC 24%; median 12%; ulnar 7% 30% single nerve injury; posterior cord 38% |
No |
| Payne et al. [17] | 48 (2.6% out of 1844) |
45.5 (15–80) Terrible triad = 4/5 pts > 57 years of age |
33:15 4:1 (triad) |
3:2 (triad) | Fall 17; MVA 14; lifting 7 | Unhappy triad 5 pts (10.4%); 2× axillary; 3× multiple nerve injury |
Total BPI-20 pts; Mononeuropathy 17 pts (axillary 47%, MSC 6%) multiple nerves 11 pts (axillary + MSC 45%; axillary + suprascap. 36%) Triad: 2× axillary; 2× axillary + suprasc.; 2× axillary + MSC |
No |
| Hems and Mahmood [18] |
101 pts 55 GHD |
Whole group 46 (14–89); BPI 52 (16–86) |
62:39 32:23 |
– | Fall 37, fall from height 6, MVA 5, skiing 3, assault 2, fall from a horse 2 |
RCT/GTF 17 (31%) 1 false aneurysm |
Complete 14; axillary 37; ulnar 39; median 35; radial 28; MSC 28; axillary rupture 3.6% (2 pts) median, ulnar worst recovery | 8 operated (15%) |
| Gutkowska et al. [19] | 73 | Mean 50 | 58:15 | 40:33 | Fall 37, fall from height 21, MVA 7, other 8 | GTF 22, RCT 7, HF 4 | Axillary 54, ulnar 51, median 48, radial 45, MCS 21 | All operated |
| Strafun et al. [20] | 25 (20.8% of 120 GHDs) | 51.52 ± 12.97 (27–66) | 18:7 | 13:12 | – |
17 RCT (16 operated-on) 8 GTF |
Axillary nerve 15 Diffuse BPI 10 |
Operated: axillary 2; BP neurolysis 4 |
| Fox et al. [21] | 22 | Mean 53 | 19:3 | – | – |
13 RCT (7 oper.) 9 GTF (7 oper.) |
Mononeuropathy 4, axillary 20, MSC 6 (cords: posterior 10; medial 8; lateral 7) | All BPIs (grafting 5) |
| Atef et al. [22] | 240 |
All 35.2 (20–60) only Axillary 46.3 Axil. + GTF 32.8 Axil. + RCT 53.9 |
176:64 | 216 domin:24 non-domin. | Fall 43.3%; fall from height 23.3%; trauma 20.8%, MVA 12.5% (incl. all axillary + GTF); triad–fall on outstretched hand |
Axillary + RCT 6.25% (15 pts) Axillary + GTF 6.25% |
Only axillary Axillary 38 pts (15.6%) Axillary alone 3.33% (8 pts) Triad age > 48 years in all pts |
No |
| Perron et al. [23] | 24 (out of 190) | 34.3 for all pts | 78%:22% (all pts) | 48%:52% (all pts) | – | 10 GTF |
All axillary 75% went off after reduction |
No |
| Gumina and Postacchini [24] | 545 GHD | Elderly | – | – | – | RCT 61% |
Axillary 9.3% Spontan. recovery in 3–12 months |
No |
| Vermeiren et al. [25] | 154 GHD (4 BPIs) | – | – | – | – | – |
Axillary 1 Radial + ulnar 3 |
No |
| Saragaglia et al. [26] | 233 GHD | – | – | – | – | – | 10 (6 axillary, 4 combined) | No |
| teSlaa et al. [27] |
105 pts 107 shoulders |
42 Whole group 39 |
– | 55:52 | 34% sport; 28% home | – |
22 nerve injuries Axillary 13 |
No |
| Lill et al. [28] | 175 GHD | – | – | – | – | – | 6 nerves: axillary 4, radial 2 | No |
| Neviaser et al. [29] | 31 | Mean 57.5 | 22:9 | – | – | RCT 100% | Axillary 4 | All RCTs operated |
| Sturm and Perry [30] | 59 (6 GHD) | 35.5 (2–84) | 45:14 | 23:33:3B | MVA 53% | – | Complete BPI 8 | No |
| Leffert and Seddon [31] | 31 pts (17 GHD) | Median age 27 | 27:4 | – | Fall 7; fall from vehicle 12, struck by car 2, MVA 4, blow 3; hyperabduction 3 | 12 GTF; 1 scapula fracture | Diffuse BPI 14 | 4 operated |
| Bumbasirevic et al. [32] | 18 | (17 > 40 years) | – | – | – | – | 50% nerve injury: axillary 38,3%; MSC 22% | No |
BPI brachial plexus injury, GTF fracture of the greater tuberosity of humerus, RCT rotator cuff tear, MVA motor vehicle accident, pts patients, MSC musculocutaneous nerve, frx fracture, GHD glenohumeral dislocation, ACD acromioclavicular dislocation, HF humeral fracture, , suprascap. suprascapular, Axil. axillary