DIAGNOSIS AND TREATMENT OF ROTATOR CUFF TEAR AND BRACHIAL PLEXUS INJURY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QIChao ¹ , CAIYan ² , YUTengbo ¹ , CHENBohua ¹ ,  MENGQingyang ³

1. Orthopaedic Center, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266003, P. R. China;
2. Medical College of Qingdao University, Qingdao Shandong, 266003, P. R. China;
3. Department of Sports Medicine, Peking University Third Hospital;

Corresponding?author：

MENGQingyang, Email: mqy19861202@163.com

Keywords：

Rotator cuff tear; Brachial plexus injury; Arthroscopy; Diagnosis

DOI：

10.7507/1002-1892.20140178

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Objective To investigate the mechanisms,diagnosis,and surgical procedures of simultaneous lesions of the rotator cuff and the brachial plexus. Methods Between July 2006 and June 2012,7 patients with rotator cuff tear associated with brachial plexus injury were treated.There were 3 males and 4 females with a mean age of 47.3 years (range,37-72 years).The reasons of injury were traumatic shoulder dislocation in 6 cases and falling injury from height in 1 case,with a mean disease duration of 17 days (range,5-31 days).The average American Shoulder and Elbow Surgeons (ASES) score was 55.86±9.42,and visual analogue scale (VAS) score was 7.14±1.35.There were 3 cases of large rotator cuff tears (>3 cm) and 4 cases of massive rotator cuff tears (>5 cm) according to Gerber standard;1 case had upper trunk injury of the brachial plexus and 6 cases had bundle branch injury of the brachial plexus according to GU Yudong's classification.The functional score of brachial plexus score was 7.43±1.27 according to the functional assessment standard by Hand Surgery Branch of Chinese Medical Association.All patients accepted arthroscopic rotator cuff repairing,and 1 case received surgical neurolysis of brachial plexus. Results All incisions healed by first intention without complication.All the 7 patients were followed up 18 to 25 months (mean,20.4 months).The function,muscle strength,and sensation of the shoulder were improved obviously.The shoulder ASES score was 84.71±8.06 and was significantly better than preoperative score (t=-8.194,P=0.000).The VAS score was 2.71±1.50 and was significantly better than preoperative score (t=7.750,P=0.000).The functional score of brachial plexus was 14.00±1.16 and was significantly better than preoperative score (t=-11.500,P=0.000). Conclusion It is difficult to simultaneously diagnose lesions of the rotator cuff and the brachial plexus;orthopedists should pay attention to possible patients to avoid missed diagnosis and diagnostic errors.Nerve nutrition,physical therapy,and arthroscopic rotator cuff repair can achieve good effectiveness.

Citation： QIChao, CAIYan, YUTengbo, CHENBohua, MENGQingyang. DIAGNOSIS AND TREATMENT OF ROTATOR CUFF TEAR AND BRACHIAL PLEXUS INJURY. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(7): 802-805. doi: 10.7507/1002-1892.20140178 Copy

1.	Mather RC 3rd,Koenig L,Acevedo D,et al.The societal and economic value of rotator cuff repair.J Bone Joint Surg (Am),2013,95(22):1993-2000.
2.	Yang LJ,Chang KW,Chung KC.A systematic review of nerve transfer and nerve repair for the treatment of adult upper brachial plexus injury.Neurosurgery,2012,71(2):417-429.
3.	Richards RR,An KN,Bigliani LU,et al.A standardized method for the assessment of shoulder function.J Shoulder Elbow Surg,1994,3(6):347-352.
4.	Fuehs B,Weishaupt D,Zanetti M,et al.Fatty degeneration of the muscles of the rotator cuff:assessment by computed tomography versus magnetic resonance imaging.J Shoulder Elbow Surg,1999,8(6):599-605.
5.	顧玉東.臂叢神經損傷的分型與手術方案.中華手外科雜志,2011,27(3):131-133.
6.	潘達德,顧玉東,侍德,等.中華醫學會手外科學會上肢部分功能評定試用標準.中華手外科雜志,2000,16(3):130-135.
7.	Murthi AM,Ramirez MA.Shoulder dislocation in the older patient.J Am Acad Orthop Surg,2012,20(10):615-622.
8.	Lisinski P,Huber J,Wilkosz P,et al.Supervised versus uncontrolled rehabilitation of patients after rotator cuff repair-clinical and neurophysiological comparative study.Int J Artif Organs,2012,35(1):45-54.
9.	趙延旭,顧立強,裴國獻.肩袖損傷合并神經損傷25例.中華創傷雜志,2006,22(11):871-872.
10.	Anderson MW,Alford BA.Overhead throwing injuries of the shoulder and elbow.Radiol Clin North Am,2010,48(6):1137-1154.
11.	Apaydin N,Tubbs RS,Loukas M,et al.Review of the surgical anatomy of the axillary nerve and the anatomic basis of is iatrogenic and traumatic injury.Surg Radiol Anat,2010,32(3):193-201.
12.	Scully WF,Wilson DJ,Parada SA,et al.Iatrogenic nerve injuries in shoulder surgery.J Am Acad Orthop Surg,2013,21(12):717-726.
13.	Castagna A,Cesari E,Garofalo R,et al.Matrix metalloproteases and their inhibitors are altered in torn rotator cuff tendons,but also in the macoscopically intact portion of those tendons.Muscles Ligaments Tendons J,2013,3(3):132-138.
14.	Pappou IP,Schmidt CC,Jarrett CD,et al.AAOS appropriate use criteria:optimizing the management of full-thickness rotator cuff tears.J Am Acad Orthop Surg,2013,21(12):772-775.
15.	Chillemi C,Marinelli M,Galizia P.Fracture-dislocation of the shoulder and brachial plexus palsy:a terrible association.J Orthop Traumatol,2008,9(4):217-220.
16.	Prasathaporn N,Kuptniratsaikul S,Kongrukgreatiyos K.Single-row repair versus double-row repair of full-thickness rotator cuff tears.Arthroscopy,2011,27(7):978-985.
17.	Abrams JS,Song FS.Arthroscopic repair techniques for massive rotator cuff tears.Instr Course Lect,2012,61:121-130.
18.	Sakoma Y,Sano H,Shinozaski N,et al.Coverage of the humeral head by the coracoacromial arch:relationship with rotator cuff tears.Acta Med Okayama,2013,67(6):377-383.

1. Mather RC 3rd,Koenig L,Acevedo D,et al.The societal and economic value of rotator cuff repair.J Bone Joint Surg (Am),2013,95(22):1993-2000.
2. Yang LJ,Chang KW,Chung KC.A systematic review of nerve transfer and nerve repair for the treatment of adult upper brachial plexus injury.Neurosurgery,2012,71(2):417-429.
3. Richards RR,An KN,Bigliani LU,et al.A standardized method for the assessment of shoulder function.J Shoulder Elbow Surg,1994,3(6):347-352.
4. Fuehs B,Weishaupt D,Zanetti M,et al.Fatty degeneration of the muscles of the rotator cuff:assessment by computed tomography versus magnetic resonance imaging.J Shoulder Elbow Surg,1999,8(6):599-605.
5. 顧玉東.臂叢神經損傷的分型與手術方案.中華手外科雜志,2011,27(3):131-133.
6. 潘達德,顧玉東,侍德,等.中華醫學會手外科學會上肢部分功能評定試用標準.中華手外科雜志,2000,16(3):130-135.
7. Murthi AM,Ramirez MA.Shoulder dislocation in the older patient.J Am Acad Orthop Surg,2012,20(10):615-622.
8. Lisinski P,Huber J,Wilkosz P,et al.Supervised versus uncontrolled rehabilitation of patients after rotator cuff repair-clinical and neurophysiological comparative study.Int J Artif Organs,2012,35(1):45-54.
9. 趙延旭,顧立強,裴國獻.肩袖損傷合并神經損傷25例.中華創傷雜志,2006,22(11):871-872.
10. Anderson MW,Alford BA.Overhead throwing injuries of the shoulder and elbow.Radiol Clin North Am,2010,48(6):1137-1154.
11. Apaydin N,Tubbs RS,Loukas M,et al.Review of the surgical anatomy of the axillary nerve and the anatomic basis of is iatrogenic and traumatic injury.Surg Radiol Anat,2010,32(3):193-201.
12. Scully WF,Wilson DJ,Parada SA,et al.Iatrogenic nerve injuries in shoulder surgery.J Am Acad Orthop Surg,2013,21(12):717-726.
13. Castagna A,Cesari E,Garofalo R,et al.Matrix metalloproteases and their inhibitors are altered in torn rotator cuff tendons,but also in the macoscopically intact portion of those tendons.Muscles Ligaments Tendons J,2013,3(3):132-138.
14. Pappou IP,Schmidt CC,Jarrett CD,et al.AAOS appropriate use criteria:optimizing the management of full-thickness rotator cuff tears.J Am Acad Orthop Surg,2013,21(12):772-775.
15. Chillemi C,Marinelli M,Galizia P.Fracture-dislocation of the shoulder and brachial plexus palsy:a terrible association.J Orthop Traumatol,2008,9(4):217-220.
16. Prasathaporn N,Kuptniratsaikul S,Kongrukgreatiyos K.Single-row repair versus double-row repair of full-thickness rotator cuff tears.Arthroscopy,2011,27(7):978-985.
17. Abrams JS,Song FS.Arthroscopic repair techniques for massive rotator cuff tears.Instr Course Lect,2012,61:121-130.
18. Sakoma Y,Sano H,Shinozaski N,et al.Coverage of the humeral head by the coracoacromial arch:relationship with rotator cuff tears.Acta Med Okayama,2013,67(6):377-383.

Chinese Journal of Reparative and Reconstructive Surgery

DIAGNOSIS AND TREATMENT OF ROTATOR CUFF TEAR AND BRACHIAL PLEXUS INJURY

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