Numbness And Tingling Following A Shoulder Dislocation

HISTORY: A 60 year old female fell backwards off of the third step of a staircase. She initially presented and had reduction of an anterior shoulder dislocation in the emergency department. Three days after injury she presented to the clinic for right shoulder pain with numbness and tingling in the first three digits of the right hand that had been constant since injury. This was her first shoulder dislocation. She had no neck pain, fever, chills, left-sided or lower extremity symptoms. PHYSICAL EXAMINATION: Right Upper Extremity: Lateral shoulder tender to palpation. Limited shoulder range of motion testing secondary to pain. Full range of motion of the elbow, wrist, and able to make a fist. Shoulder strength testing limited. Normal strength with elbow flexion, extension, wrist flexion and extension, abductor pollicis brevis and flexor pollicis longus. Spurling’s and Hoffman’s maneuvers were negative. Tinel’s positive at the wrist and over the pronator teres. No thenar atrophy. Good radial pulses and capillary refill. No other wounds, lacerations, bruises or masses noted. DIFFERENTIAL DIAGNOSIS: Carpal Tunnel Syndrome, Pronator Syndrome, Proximal Median Nerve Neuropraxia, Cervical Radiculopathy TEST AND RESULTS: Right Shoulder radiographs: Anterior shoulder dislocation with acute Hill-Sachs lesion. Right Shoulder radiographs post-reduction: Anatomic alignment status post reduction. MRI of the Right Shoulder: Subacute minimally displaced fracture of the greater tuberosity with partial-thickness supraspinatus tear. EMG/NCS: Right median nerve slowing of greater than 10 meters/seconds noted from the Erb's point to the axilla with abnormal MUAP morphology in the right pronator teres and APB. Right median nerve with markedly reduced amplitude with normal latency and conduction velocity. TREATMENT AND OUTCOMES: A therapeutic and diagnostic block was trialed at both the median nerve at the wrist and at the forearm on separate visits. She has no relief at the wrist and partial relief of neuropathic symptoms at the forearm. She was referred to formal physical therapy and started on gabapentin for nerve symptoms. She will continue to follow up as symptoms evolve over the next year.