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Despite the abundance of literature on neurological injury associated with shoulder dislocation, very few studies specifically report on the incidence of complete brachial plexus palsy. Previous studies have reported the incidence between 12 and 13.5%. Nerve injury is not uncommon following shoulder dislocation. One year after the original injury, her exam revealed only mild motor and sensory impairment in the affected hand. Over the next 6 weeks, the patient demonstrated dramatic motor and sensory improvement while participating in a program of physical and occupational therapy. Magnetic resonance imaging (MRI) of the cervical spine was obtained to rule out cervical root avulsion but revealed only mild spondylosis. Electromyography and nerve conduction studies (EMG/NCS) were obtained 2 weeks later and confirmed a severe multi-trunk brachial plexopathy characterized by both conduction block and motor axon loss. At 1-week follow-up with her orthopedic physician, the exam demonstrated persistent loss of motor and sensory function. She was discharged from the emergency department in a shoulder immobilizer with instructions to follow up with her orthopedist.

Computed tomography (CT) of the head was obtained due to the severity of her neurologic deficits. The shoulder dislocation was then uneventfully reduced within 90 min of dislocation with radiographic confirmation (Fig. Plain radiographs were obtained, including AP and scapular Y views, demonstrating an anterior dislocation without evidence of acute fracture (Fig. There was no evidence of any other cognitive or neurologic deficit. A neurologic examination in the emergency department was performed prior to joint reduction and confirmed marked ipsilateral sensory and motor loss of the upper extremity. Her surgical history was significant for an uncomplicated right shoulder arthroscopy and arthroscopic capsular release for adhesive capsulitis of the shoulder 10 years previously. The patient’s past medical history included steroid-dependent asthma, type 2 diabetes, and class 1 obesity (BMI 34). Neurovascular injuries in the setting of shoulder dislocation may be present despite low-energy injury mechanisms.Ī 55-year-old woman presented to a community hospital emergency department with an acute anterior right shoulder dislocation with ipsilateral upper extremity paresthesias and weakness following a violent sneeze. Follow-up at 1 year revealed marked improvement of motor and sensory function of the affected extremity with mild residual weakness and paresthesias in the affected hand. Her neurologic deficits gradually improved through a program of supervised therapy and orthopedic care. The shoulder was reduced without difficulty in the emergency department within 90 min of dislocation, and the patient was discharged. Case presentationĪ 55-year-old woman presented to the emergency department with a complete brachial plexus palsy from an acute anterior shoulder dislocation following a violent sneeze.

Although clinical intuition may suggest that a higher-energy mechanism is required to produce neurovascular sequelae, the existing literature does not support this supposition. Due to the anatomy of the shoulder, associated neurovascular damage is not uncommon. Nerve damage in hand.Traumatic shoulder dislocation is a frequent condition presenting to the emergency department.