Surgical Management and Outcomes of Iatrogenic Nerve Injuries Following Elective Shoulder Surgery: A Tertiary Referral Center Experience

Introduction: Iatrogenic nerve injury following elective shoulder surgery is an uncommon but potentially devastating complication. This study reports the surgical management and outcomes of iatrogenic nerve injuries requiring operative intervention at a tertiary referral center. Methods: A retrospective review was performed of patients who underwent upper extremity neurolysis, nerve transfer, or nerve grafting procedures between January 2008 and August 2025 following complications from elective shoulder surgery. Demographics, index procedure, time to nerve intervention, operative findings, and clinical outcomes were analyzed. Results: Twenty-seven patients underwent surgical nerve intervention following elective shoulder surgery. Mean age was 58 years (59% female). Index procedures included reverse total shoulder arthroplasty (n=11), anatomic total shoulder arthroplasty (n=3), and various arthroscopic procedures (n=11). Mean interval from index surgery to clinic referral was 241 days, with an additional 67 days to surgical intervention. Terminal nerve branches were most commonly injured (63%), followed by nerve root or upper trunk (19%). Neurolysis was performed in 22 patients, nerve transfers in 2, and neuroma excision with direct repair in 2. Mean VAS pain scores decreased from 5.2 to 3.18 (p<0.01). Among patients with sensory deficits, 61% reported complete resolution and 39% reported improvement. Of patients with motor weakness, 85% demonstrated strength improvements. Conclusion: Among patients requiring surgical nerve intervention after elective shoulder surgery, neurolysis, and nerve reconstruction were associated with improvements in pain, sensation, and motor function. The mean 8-month delay from index surgery to referral highlights the need for earlier evaluation of suspected iatrogenic nerve injuries to optimize reinnervation potential.