In the Journals

Brachial plexus nerves may be at risk during Latarjet procedure

During the Latarjet procedure, the axillary and musculocutaneous nerves were found to be at risk, especially during glenoid exposure and graft insertion, according to study results.

Researchers performed the Latarjet procedure in 34 patients with shoulder instability, continuously monitoring bilateral median and ulnar somatosensory evoked responses and transcranial motor evoked potentials from all arm myotomes. They defined a nerve alert as an averaged 50% amplitude attenuation or 10% latency prolongation of ipsilateral somatosensory evoked responses and transcranial motor evoked potentials. The surgeon altered retractor placement for each nerve alert and changed the position of the operative extremity if there was no response to the alteration.

Study results showed 26 patients had 45 separate nerve alert episodes, with nerve alerts occurring most commonly during glenoid exposure and graft insertion. The researchers found the axillary nerve was involved in 35 alerts and the musculocutaneous nerve in 22.

A clinically detectable nerve deficit was postoperatively identified in seven patients, and all were correlated from 28 to 165 days after the procedure.

Although prior surgery and body mass index were not predictive of a neurologic deficit postoperatively, total operative time and duration of the stage of the procedure in which the concordant nerve alert occurred were statistically significant predictors of postoperative nerve deficit, according to the researchers.

Disclosures: Freehill is a consultant for Smith & Nephew. Higgins and Warner received fellowship support from Arthrocare, DJ Orthopaedics, Arthrex, Mitek, Breg and Smith & Nephew. Warner also received royalties from Tornier and has equity in Orthospace and Vumedi.

During the Latarjet procedure, the axillary and musculocutaneous nerves were found to be at risk, especially during glenoid exposure and graft insertion, according to study results.

Researchers performed the Latarjet procedure in 34 patients with shoulder instability, continuously monitoring bilateral median and ulnar somatosensory evoked responses and transcranial motor evoked potentials from all arm myotomes. They defined a nerve alert as an averaged 50% amplitude attenuation or 10% latency prolongation of ipsilateral somatosensory evoked responses and transcranial motor evoked potentials. The surgeon altered retractor placement for each nerve alert and changed the position of the operative extremity if there was no response to the alteration.

Study results showed 26 patients had 45 separate nerve alert episodes, with nerve alerts occurring most commonly during glenoid exposure and graft insertion. The researchers found the axillary nerve was involved in 35 alerts and the musculocutaneous nerve in 22.

A clinically detectable nerve deficit was postoperatively identified in seven patients, and all were correlated from 28 to 165 days after the procedure.

Although prior surgery and body mass index were not predictive of a neurologic deficit postoperatively, total operative time and duration of the stage of the procedure in which the concordant nerve alert occurred were statistically significant predictors of postoperative nerve deficit, according to the researchers.

Disclosures: Freehill is a consultant for Smith & Nephew. Higgins and Warner received fellowship support from Arthrocare, DJ Orthopaedics, Arthrex, Mitek, Breg and Smith & Nephew. Warner also received royalties from Tornier and has equity in Orthospace and Vumedi.