David Pope1, Christopher Wottowa2. 1. Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA. 2. Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA; Springfield Clinic, Springfield, IL, USA. Electronic address: cwottowa@comcast.net.
Abstract
BACKGROUND: Anterior interosseous nerve (AIN) palsies can arise spontaneously or be attributed to one of many causes. We present 4 cases, the largest series to date, in which a mixed peripheral neuropathy presented primarily as an AIN palsy following ipsilateral shoulder arthroscopy. In this report, we detail the patient's presenting symptoms, describe our management of the complication, and provide hypotheses for the mechanism behind the complication. METHODS: Four different surgeons performed the initial arthroscopic surgeries, but the senior author in all cases managed follow-up and treatment of the neuropathy. All patients were informed and agreed to have their cases published. RESULTS: All four patients experienced significant recovery, although 2 of 4 required AIN decompression and exploration because of failure to improve with conservative management. CONCLUSION: Whereas variables such as position, index surgical procedure, and use of regional anesthesia varied among our patients, the one constant was the fluid extravasation from the arthroscopy itself, and for this reason we believe that if there is one singular cause to explain all of these neuropathies, it would be increased pressure in the upper arm and forearm from fluid extravasation in patients with at-risk anatomy. Outside of prevention, recognizing this complication and providing appropriate intervention or referral to a surgeon capable of appropriate intervention are important for any surgeon performing shoulder arthroscopies.
BACKGROUND: Anterior interosseous nerve (AIN) palsies can arise spontaneously or be attributed to one of many causes. We present 4 cases, the largest series to date, in which a mixed peripheral neuropathy presented primarily as an AIN palsy following ipsilateral shoulder arthroscopy. In this report, we detail the patient's presenting symptoms, describe our management of the complication, and provide hypotheses for the mechanism behind the complication. METHODS: Four different surgeons performed the initial arthroscopic surgeries, but the senior author in all cases managed follow-up and treatment of the neuropathy. All patients were informed and agreed to have their cases published. RESULTS: All four patients experienced significant recovery, although 2 of 4 required AIN decompression and exploration because of failure to improve with conservative management. CONCLUSION: Whereas variables such as position, index surgical procedure, and use of regional anesthesia varied among our patients, the one constant was the fluid extravasation from the arthroscopy itself, and for this reason we believe that if there is one singular cause to explain all of these neuropathies, it would be increased pressure in the upper arm and forearm from fluid extravasation in patients with at-risk anatomy. Outside of prevention, recognizing this complication and providing appropriate intervention or referral to a surgeon capable of appropriate intervention are important for any surgeon performing shoulder arthroscopies.