Distribution of Peripheral Nerve Injuries in Patients with a History of Shoulder Trauma Referred to a Tertiary Care Electrodiagnostic Laboratory

Peripheral nerve injury after shoulder trauma is an underestimated complication. The distribution of the affected nerves has been reported to be heterogeneous in previous studies. This study aimed to describe the distribution of peripheral nerve injuries in patients with a history of shoulder trauma who were referred to a tertiary care electrodiagnostic laboratory. A retrospective chart review was performed for all cases referred to a tertiary care electrodiagnostic laboratory between March 2012 and February 2020. The inclusion criteria were a history of shoulder trauma and electrodiagnostic evidence of nerve injury. Data on patient demographics, mechanism of injury, degree of weakness, clinical outcomes at the final follow-up, and electrodiagnostic results were retrieved from medical records. Fifty-six patients had peripheral nerve injuries after shoulder trauma. Overall, isolated axillary nerve injury was the most common. A brachial plexus lesion affecting the supraclavicular branches (pan-brachial plexus and upper trunk brachial plexus lesions) was the second most common injury. In cases of shoulder dislocation and proximal humerus fracture, isolated axillary nerve injury was the most common. Among acromioclavicular joint injuries and clavicular fractures, lower trunk brachial plexus injuries and ulnar neuropathy were more common than axillary nerve or upper trunk brachial plexus injuries. Patients with isolated axillary nerve lesions showed a relatively good recovery; those with pan-brachial plexus injuries showed a poor recovery. Our study demonstrated the distribution of peripheral nerve injuries remote from displaced bony structures. Mechanisms other than direct compression by displaced bony structures might be involved in nerve injuries associated with shoulder trauma. Electrodiagnostic tests are useful for determining the extent of nerve damage after shoulder trauma.

Use of Ultrasound for Diagnosis of Clavicle Fractures in the Emergency Department

Background: Plain radiography is the method for diagnosing the fracture of the clavicle. The use of US to diagnose clavicle fracture has several advantages when compared to radiography. It could prevent the patient from radiation exposure, especially in vulnerable populations. It may also expedite the diagnosis and decrease the length of stay in the ED. In this study we aimed to discuss the diagnostic success of ultrasonography versus x-ray. Materials and Method: All patients admitted to the emergency department with a shoulder trauma were investigated for their eligibility to be included in the study. A standardized ultrasonography performed by the same investigator to vizualise clavicle from sternal junction through acromial junction. After ultrasonography, plain radiography was performed. Results: The mean age was 45.53 (min = 18; max = 86; SD = 18.791) years and 72.7% were male. Among all patients, 42 clavicula fractures were detected via graphy and 26 (62%) were seen in males and 57 patients with no clavicle fractures. The sensitivity of US to radiographically detected fracture was 92.86% (95%CI, 80.52% to 98.5%), and the specificity was 98.25% (95%CI = 90.61% to 99.96%). The PPV was 97.5% (84.8% to 99.63%) and the NPV was 94.92% (95% CI = 86.23% to 98.23%). Conclusions: Ultrasonography is a good alternative for diagnosing clavicle fracture. Future studies should examine the use of ultrasonography as a method for diagnosing of clavicle fracture by emergency physicians with only basic ultrasonographic training.