This prospective study looked at how often nerve and rotator cuff injuries accompany anterior shoulder dislocation in patients over 40. Using EMG and ultrasound rather than clinical exam alone, it measured the true rate of these early complications. Patients were followed by phone at about 3 years to link initial injury to lasting symptoms.
When an older patient dislocates a shoulder, do not stop at reduction and a sling. This paper shows that roughly 75% carry a nerve and/or cuff injury that clinical exam alone misses. The key clinical trap: weak abduction after reduction can mean an axillary nerve palsy, a rotator cuff tear, or both. About half of patients with cuff tears also had axillary nerve involvement, so the two coexist.
That is why the authors recommend close follow-up in the first weeks. Persistent inability or weakness to abduct should trigger EMG and ultrasound rather than a wait-and-see approach.
Useful prognostic anchors: most axillary nerve palsies recover in 3-12 months, but persistent denervation past 4 months raises the question of nerve graft. And an initial nerve or cuff lesion predicts lasting symptoms at 3 years.
This prospective study looked at how often nerve and rotator cuff injuries accompany anterior shoulder dislocation in patients over 40. Using EMG and ultrasound rather than clinical exam alone, it measured the true rate of these early complications. Patients were followed by phone at about 3 years to link initial injury to lasting symptoms.
When an older patient dislocates a shoulder, do not stop at reduction and a sling. This paper shows that roughly 75% carry a nerve and/or cuff injury that clinical exam alone misses. The key clinical trap: weak abduction after reduction can mean an axillary nerve palsy, a rotator cuff tear, or both. About half of patients with cuff tears also had axillary nerve involvement, so the two coexist.
That is why the authors recommend close follow-up in the first weeks. Persistent inability or weakness to abduct should trigger EMG and ultrasound rather than a wait-and-see approach.
Useful prognostic anchors: most axillary nerve palsies recover in 3-12 months, but persistent denervation past 4 months raises the question of nerve graft. And an initial nerve or cuff lesion predicts lasting symptoms at 3 years.