Zenuwletsel bij primaire schouderluxaties en subcapitale humerusfracturen

To determine incidence and gravity of nerve injury after primary shoulder dislocations and humeral neck fractures.

Design

Prospective follow-up study.

Setting

Leyenburg Hospital, the Hague, the Netherlands.

Method

101 patients with a shoulder dislocation or humeral neck fracture were examinated clinically. Special attention was paid to function, muscle force and indications for nerve injury. In patients with suspicion of nerve injury or if clinical testing could not be performed due to severe pain an extensive electrophysiological assessment was carried out. Patients were treated with immobilisation for one to four weeks. Thereafter passive and active exercises, if necessary with the aid of a physiotherapist, were prescribed.

Results

In 45101 (45) of the patients an axonal nerve lesion was found. In elderly patients (> 65 years) the frequency was 54 (3463). The nerves most frequently affected by neuropathy were the axillary, suprascapular, musculocutaneus and radial nerves. The ratio of nerve lesions in the fracture and dislocation groups was 53:34. Patients with haematoma or with paresis of the deltoid muscle had a significantly higher frequency of nerve palsy. The presence of sensory loss or muscular atrophy was not associated with a higher frequency of nerve lesions. At the mean follow-up of four months most patients had recovered well clinically.

Conclusion

Almost half of the patients had electromyographically confirmed nerve lesions. Early diagnosis (with EMG in patients who need a well functioning shoulder) and an early start of active exercise supervised by a physiotherapist are of great value for recovery.