Repair of complete median nerve transection from shoulder arthroscopy following rotator cuff injury

Abstract

Background: Nerve injury following arthroscopic shoulder procedures is a rare complication. Most patients will have gradual resolution of symptoms. Operative management may be required in the setting of complete nerve injury. Purpose: We present a case detailing our experience managing a patient with a complete median nerve transection following shoulder arthroscopy for a rotator cuff injury. Case Description: A thirty-nine-year-old female was referred to our office five months after undergoing a shoulder arthroscopy for a rotator cuff repair. Upon waking up from her initial surgery, she reported pain, numbness, and weakness in her right arm and hand, including the inability to make a fist or fully flex her first or second fingers. She was found to have right thenar eminence atrophy. Motor exam revealed profound weakness in flexors of the thumb and index finger. Because of the high likelihood of median nerve injury given the patient’s clinical presentation and surgical history along with an unremarkable brachial plexus MRI, surgery was recommended. Upon surgical exposure, the median nerve was found to be completely transected with a large neuroma. The neuroma was removed, and the nerve ends were trimmed with a sural nerve graft used to complete the repair. At her one and a half year follow up, she continued to demonstrate improvement although still complained of numbness in her first three fingers and weakness in her right hand. However, unlike preoperatively, her pain was well-controlled. Conclusion: Although distal neuropathies are a common preoperative complaint of patients with rotator cuff injuries, new onset nerve injuries as a complication from surgical repair should not be overlooked. Prevention of nerve injury is critical through adequate exposure and positioning during surgery. If a nerve injury does occur, examination during follow up visits are critical for monitoring the progression of symptoms and need for additional interventions.

Keywords

• Median nerve
• Nerve transection
• Shoulder arthroscopy
• Surgical repair
• Nerve graft