Prospective study of 30 consecutive shoulder arthroplasty patients using continuous intraoperative brachial plexus monitoring — including transcranial electrical MEPs and spontaneous EMG — to determine the true incidence, anatomic pattern, and predisposing factors of nerve injury during surgery, compared against postoperative EMG confirmation.
When you're operating on a stiff shoulder with prior open surgery — particularly if passive ER is under 10°.
Recognize that more than three-quarters of these patients may experience intraoperative nerve compromise; minimize time in extreme ER/extension/abduction, and return the arm to neutral at any surgical pause.
If MEPs never normalize by case end, counsel the patient: they have roughly a 57% chance of a positive postoperative EMG, and you should plan follow-up EMG at 4+ weeks.
Prospective study of 30 consecutive shoulder arthroplasty patients using continuous intraoperative brachial plexus monitoring — including transcranial electrical MEPs and spontaneous EMG — to determine the true incidence, anatomic pattern, and predisposing factors of nerve injury during surgery, compared against postoperative EMG confirmation.
When you're operating on a stiff shoulder with prior open surgery — particularly if passive ER is under 10°.
Recognize that more than three-quarters of these patients may experience intraoperative nerve compromise; minimize time in extreme ER/extension/abduction, and return the arm to neutral at any surgical pause.
If MEPs never normalize by case end, counsel the patient: they have roughly a 57% chance of a positive postoperative EMG, and you should plan follow-up EMG at 4+ weeks.