{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T23:37:30Z","timestamp":1791589050740,"version":"4.3.4"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T00:00:00Z","timestamp":1665964800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T00:00:00Z","timestamp":1665964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005788","name":"Medical University of Vienna","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005788","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Orthop Trauma Surg"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>Iatrogenic nerve injury in orthopedic surgery can impair functional outcomes. During the last years, a steady increase in the number of performed reverse total shoulder arthroplasties has been reported and complications associated with this procedure are continuously described. Neurological complications, however, remain underreported. The aims of this study were to calculate the incidence of iatrogenic nerve injury after primary and revision reverse total shoulder arthroplasty in a large patient cohort, as well as identify associated patient-and surgery-related risk factors.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>A retrospective review of our institution\u2019s internal Reverse Total Shoulder Arthroplasty (RTSA) database from September 2005 to December 2019 was undertaken and 34 patients with iatrogenic nerve injuries were identified, resulting in a neurological complication rate of 2.6%. Group comparisons between patients with nerve injuries (<jats:italic>n<\/jats:italic>\u2009=\u200934) and the remaining cohort without nerve injuries (<jats:italic>n<\/jats:italic>\u2009=\u20091275) were performed to identify patient- and surgery-related risk factors.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of the 34 cases with iatrogenic nerve injury, damage to terminal nerve branches occurred in 21 patients, whereas a brachial plexus lesion was diagnosed in the other 13. Nerve revision surgery was necessary in four patients. At final follow-up 13 patients (45%) had residual motor deficits and 17 (59%) had residual sensory deficits. Higher numbers of previous surgeries of the affected shoulder correlated with subsequent nerve injury (<jats:italic>p<\/jats:italic>\u2009=\u20090.035). Operative time was significantly longer in patients, who developed a neurologic deficit, showing a correlation between duration of surgery and occurrence of nerve injury (<jats:italic>p<\/jats:italic>\u2009=\u20090.013). Patients with neurologic complications were significantly younger than patients without nerve damage (median 68 vs. 72\u00a0years, <jats:italic>p<\/jats:italic>\u2009=\u20090.017).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>In specialists\u2019 hands reverse total shoulder arthroplasty is a rather safe procedure regarding the risk of neurologic injury. However, multiple previous surgeries of the affected shoulder increase the risk of neurological complications. Cases with post-operative neurologic compromise are rare and usually recover well, with few patients suffering long-term functional deficits from iatrogenic nerve injury.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Level of evidence<\/jats:title>\n                <jats:p>Level III, retrospective cohort study.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00402-022-04641-9","type":"journal-article","created":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T03:15:16Z","timestamp":1665976516000},"page":"3899-3907","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Iatrogenic nerve injury in primary and revision reverse total shoulder arthroplasty"],"prefix":"10.1007","volume":"143","author":[{"given":"Laura A.","family":"Hruby","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Unterfrauner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Casari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Kriechling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Bouaicha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Wieser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,10,17]]},"reference":[{"issue":"5","key":"4641_CR1","doi-asserted-by":"publisher","first-page":"e185","DOI":"10.5435\/JAAOS-D-18-00608","volume":"28","author":"R Gupta","year":"2020","unstructured":"Gupta R et al (2020) Understanding and treating iatrogenic nerve injuries in shoulder surgery. J Am Acad Orthop Surg 28(5):e185\u2013e192","journal-title":"J Am Acad Orthop Surg"},{"issue":"12","key":"4641_CR2","doi-asserted-by":"publisher","first-page":"717","DOI":"10.5435\/00124635-201312000-00002","volume":"21","author":"WF Scully","year":"2013","unstructured":"Scully WF et al (2013) Iatrogenic nerve injuries in shoulder surgery. J Am Acad Orthop Surg 21(12):717\u2013726","journal-title":"J Am Acad Orthop Surg"},{"issue":"24","key":"4641_CR3","doi-asserted-by":"publisher","first-page":"2249","DOI":"10.2106\/JBJS.J.01994","volume":"93","author":"SH Kim","year":"2011","unstructured":"Kim SH et al (2011) Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am 93(24):2249\u20132254","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"4641_CR4","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/j.jse.2014.08.026","volume":"24","author":"WW Schairer","year":"2015","unstructured":"Schairer WW et al (2015) National utilization of reverse total shoulder arthroplasty in the United States. J Shoulder Elbow Surg 24(1):91\u201397","journal-title":"J Shoulder Elbow Surg"},{"key":"4641_CR5","doi-asserted-by":"crossref","unstructured":"Best MJ et al (2021) Increasing incidence of primary reverse and anatomic total shoulder arthroplasty in the United States. J Shoulder Elbow Surg 30(5):1159\u20131166","DOI":"10.1016\/j.jse.2020.08.010"},{"key":"4641_CR6","doi-asserted-by":"crossref","unstructured":"Kriechling P et al (2021) Primary reverse total shoulder arthroplasty in patients older than 80 years: clinical and radiologic outcome measures. J Shoulder Elbow Surg 30(4):877\u2013883","DOI":"10.1016\/j.jse.2020.07.032"},{"issue":"1","key":"4641_CR7","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1007\/s11999-008-0406-1","volume":"467","author":"C Wierks","year":"2009","unstructured":"Wierks C et al (2009) Reverse total shoulder replacement: intraoperative and early postoperative complications. Clin Orthop Relat Res 467(1):225\u2013234","journal-title":"Clin Orthop Relat Res"},{"issue":"7","key":"4641_CR8","doi-asserted-by":"publisher","first-page":"439","DOI":"10.5435\/00124635-201107000-00007","volume":"19","author":"E Cheung","year":"2011","unstructured":"Cheung E et al (2011) Complications in reverse total shoulder arthroplasty. J Am Acad Orthop Surg 19(7):439\u2013449","journal-title":"J Am Acad Orthop Surg"},{"issue":"6","key":"4641_CR9","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1016\/j.jse.2015.10.012","volume":"25","author":"D Villacis","year":"2016","unstructured":"Villacis D et al (2016) Complication rate and implant survival for reverse shoulder arthroplasty versus total shoulder arthroplasty: results during the initial 2 years. J Shoulder Elbow Surg 25(6):927\u2013935","journal-title":"J Shoulder Elbow Surg"},{"issue":"8","key":"4641_CR10","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.1007\/s00264-010-1125-2","volume":"34","author":"M Farshad","year":"2010","unstructured":"Farshad M, Gerber C (2010) Reverse total shoulder arthroplasty-from the most to the least common complication. Int Orthop 34(8):1075\u20131082","journal-title":"Int Orthop"},{"issue":"1","key":"4641_CR11","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1016\/j.jse.2010.08.001","volume":"20","author":"MA Zumstein","year":"2011","unstructured":"Zumstein MA et al (2011) Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 20(1):146\u2013157","journal-title":"J Shoulder Elbow Surg"},{"issue":"1 Suppl","key":"4641_CR12","doi-asserted-by":"publisher","first-page":"S33","DOI":"10.1016\/j.otsr.2015.06.031","volume":"102","author":"P Boileau","year":"2016","unstructured":"Boileau P (2016) Complications and revision of reverse total shoulder arthroplasty. Orthop Traumatol Surg Res 102(1 Suppl):S33\u2013S43","journal-title":"Orthop Traumatol Surg Res"},{"issue":"14","key":"4641_CR13","doi-asserted-by":"publisher","first-page":"1288","DOI":"10.2106\/JBJS.J.00369","volume":"93","author":"A L\u00e4dermann","year":"2011","unstructured":"L\u00e4dermann A et al (2011) Prevalence of neurologic lesions after total shoulder arthroplasty. J Bone Joint Surg Am 93(14):1288\u20131293","journal-title":"J Bone Joint Surg Am"},{"key":"4641_CR14","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1097\/00003086-199005000-00014","volume":"254","author":"K Hamada","year":"1990","unstructured":"Hamada K et al (1990) Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res 254:92\u201396","journal-title":"Clin Orthop Relat Res"},{"issue":"10","key":"4641_CR15","doi-asserted-by":"publisher","first-page":"1601","DOI":"10.1016\/j.jse.2016.03.010","volume":"25","author":"MJ Bercik","year":"2016","unstructured":"Bercik MJ et al (2016) A modification to the Walch classification of the glenoid in primary glenohumeral osteoarthritis using three-dimensional imaging. J Shoulder Elbow Surg 25(10):1601\u20131606. https:\/\/doi.org\/10.1016\/j.jse.2016.03.010","journal-title":"J Shoulder Elbow Surg"},{"issue":"5","key":"4641_CR16","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1016\/j.jse.2006.01.003","volume":"15","author":"P Boileau","year":"2006","unstructured":"Boileau P et al (2006) Neer Award 2005: The Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg 15(5):527\u2013540","journal-title":"J Shoulder Elbow Surg"},{"issue":"3","key":"4641_CR17","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1016\/j.jse.2011.05.023","volume":"21","author":"B Leung","year":"2012","unstructured":"Leung B et al (2012) Functional outcome of hemiarthroplasty compared with reverse total shoulder arthroplasty in the treatment of rotator cuff tear arthropathy. J Shoulder Elbow Surg 21(3):319\u2013323","journal-title":"J Shoulder Elbow Surg"},{"issue":"6","key":"4641_CR18","doi-asserted-by":"publisher","first-page":"1096","DOI":"10.1016\/j.jse.2019.11.014","volume":"29","author":"HJ Kim","year":"2020","unstructured":"Kim HJ et al (2020) Neurologic deficit after reverse total shoulder arthroplasty: correlation with distalization. J Shoulder Elbow Surg 29(6):1096\u20131103","journal-title":"J Shoulder Elbow Surg"},{"issue":"7","key":"4641_CR19","doi-asserted-by":"publisher","first-page":"1275","DOI":"10.1016\/j.jse.2017.12.030","volume":"27","author":"Y Lopiz","year":"2018","unstructured":"Lopiz Y et al (2018) Injury to the axillary and suprascapular nerves in rotator cuff arthropathy and after reverse shoulder arthroplasty: a prospective electromyographic analysis. J Shoulder Elbow Surg 27(7):1275\u20131282","journal-title":"J Shoulder Elbow Surg"},{"issue":"1","key":"4641_CR20","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.otsr.2013.09.006","volume":"100","author":"A L\u00e4dermann","year":"2014","unstructured":"L\u00e4dermann A et al (2014) Injury to the axillary nerve after reverse shoulder arthroplasty: an anatomical study. Orthop Traumatol Surg Res 100(1):105\u2013108","journal-title":"Orthop Traumatol Surg Res"},{"issue":"10","key":"4641_CR21","doi-asserted-by":"publisher","first-page":"2042","DOI":"10.1016\/j.injury.2017.06.024","volume":"48","author":"T Leschinger","year":"2017","unstructured":"Leschinger T et al (2017) The risk of suprascapular and axillary nerve injury in reverse total shoulder arthroplasty: an anatomic study. Injury 48(10):2042\u20132049","journal-title":"Injury"},{"issue":"3 Suppl","key":"4641_CR22","doi-asserted-by":"publisher","first-page":"S2","DOI":"10.1016\/j.jse.2006.01.016","volume":"16","author":"SH Nagda","year":"2007","unstructured":"Nagda SH et al (2007) Neer Award 2005: Peripheral nerve function during shoulder arthroplasty using intraoperative nerve monitoring. J Shoulder Elbow Surg 16(3 Suppl):S2\u2013S8","journal-title":"J Shoulder Elbow Surg"},{"issue":"7","key":"4641_CR23","doi-asserted-by":"publisher","first-page":"1122","DOI":"10.1016\/j.jse.2016.02.016","volume":"25","author":"RL Parisien","year":"2016","unstructured":"Parisien RL et al (2016) The risk of nerve injury during anatomical and reverse total shoulder arthroplasty: an intraoperative neuromonitoring study. J Shoulder Elbow Surg 25(7):1122\u20131127","journal-title":"J Shoulder Elbow Surg"},{"key":"4641_CR24","doi-asserted-by":"crossref","unstructured":"Patel MS et al (2021) Incidence of peripheral nerve injury in revision total shoulder arthroplasty: an intraoperative nerve monitoring study. J Shoulder Elbow Surg 30(7):1603\u20131612","DOI":"10.1016\/j.jse.2020.09.024"},{"issue":"2","key":"4641_CR25","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1053\/bean.2002.0234","volume":"16","author":"A Borgeat","year":"2002","unstructured":"Borgeat A, Ekatodramis G (2002) Anaesthesia for shoulder surgery. Best Pract Res Clin Anaesthesiol 16(2):211\u2013225","journal-title":"Best Pract Res Clin Anaesthesiol"},{"issue":"Suppl 1","key":"4641_CR26","doi-asserted-by":"publisher","first-page":"i97","DOI":"10.1093\/bja\/aeq273","volume":"105","author":"CL Jeng","year":"2010","unstructured":"Jeng CL, Torrillo TM, Rosenblatt MA (2010) Complications of peripheral nerve blocks. Br J Anaesth 105(Suppl 1):i97\u2013i107","journal-title":"Br J Anaesth"},{"issue":"1","key":"4641_CR27","first-page":"54","volume":"77","author":"CL Jeng","year":"2011","unstructured":"Jeng CL, Rosenblatt MA (2011) Intraneural injections and regional anesthesia: the known and the unknown. Minerva Anestesiol 77(1):54\u201358","journal-title":"Minerva Anestesiol"},{"issue":"4","key":"4641_CR28","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1097\/00000542-200110000-00015","volume":"95","author":"A Borgeat","year":"2001","unstructured":"Borgeat A et al (2001) Acute and nonacute complications associated with interscalene block and shoulder surgery: a prospective study. Anesthesiology 95(4):875\u2013880","journal-title":"Anesthesiology"},{"issue":"11","key":"4641_CR29","doi-asserted-by":"publisher","first-page":"1647","DOI":"10.1016\/j.jse.2014.04.015","volume":"23","author":"BM Saltzman","year":"2014","unstructured":"Saltzman BM et al (2014) Complication rates comparing primary with revision reverse total shoulder arthroplasty. J Shoulder Elbow Surg 23(11):1647\u20131654","journal-title":"J Shoulder Elbow Surg"},{"issue":"12","key":"4641_CR30","doi-asserted-by":"publisher","first-page":"2789","DOI":"10.1007\/s00264-019-04349-3","volume":"43","author":"J Rojas","year":"2019","unstructured":"Rojas J et al (2019) Exposure of the brachial plexus in complex revisions to reverse total shoulder arthroplasty. Int Orthop 43(12):2789\u20132797","journal-title":"Int Orthop"},{"issue":"1","key":"4641_CR31","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.jse.2016.05.020","volume":"26","author":"F Grubhofer","year":"2017","unstructured":"Grubhofer F et al (2017) Reverse total shoulder arthroplasty for failed open reduction and internal fixation of fractures of the proximal humerus. J Shoulder Elbow Surg 26(1):92\u2013100","journal-title":"J Shoulder Elbow Surg"},{"issue":"5","key":"4641_CR32","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1007\/s00264-013-2175-z","volume":"38","author":"A L\u00e4dermann","year":"2014","unstructured":"L\u00e4dermann A, Edwards TB, Walch G (2014) Arm lengthening after reverse shoulder arthroplasty: a review. Int Orthop 38(5):991\u20131000","journal-title":"Int Orthop"}],"container-title":["Archives of Orthopaedic and Trauma Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-022-04641-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00402-022-04641-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-022-04641-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T19:08:55Z","timestamp":1687806535000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00402-022-04641-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,17]]},"references-count":32,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["4641"],"URL":"https:\/\/doi.org\/10.1007\/s00402-022-04641-9","relation":{},"ISSN":["1434-3916"],"issn-type":[{"value":"1434-3916","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,17]]},"assertion":[{"value":"6 February 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 September 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 October 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare they have no financial interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The Cantonal Ethics Committee Zurich approved the conduction of this study (no. 2018-01494).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"All patients gave written informed consent to participate.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}