Shrug radiographs for the diagnosis of long thoracic nerve palsy in traumatic brachial plexus injury

Background: Preoperative diagnosis of long thoracic nerve (LTN) palsy is important for shoulder reconstruction after a traumatic brachial plexus injury (BPI). In the present study, we developed an objective diagnostic method for LTN palsy for patients with traumatic BPI. Methods: This is a retrospective review of 56 patients with traumatic BPI who had been receiving treatment at a single institution for over 8 years. The patients were divided into 2 groups: an LTN palsy group (n = 30) and a no palsy control group (n = 26). The LTN palsy group had 21 different palsy types with 4 and 5 C5-7 and C5-8, whereas the no palsy group had 18 different palsy types with 5 and 3 C5-6 and C5-8, respectively. Preoperative plain anteroposterior radiographs were taken in shoulder adduction and shrug positions. Scapulothoracic (ST) upward rotation and clavicle lateral (CL) rotation angles were measured on X-rays. The differences between the adduction and shrug positions for the respective angles were calculated and defined as Phi(ST) and Phi(CL), respectively. The differences in the Phi(ST) and Phi(CL) values due to the presence or absence of LTN palsy were examined, the cutoff values of Phi(ST) and Phi(CL) for the diagnosis of LTN palsy were determined, and further sensitivity and specificity were calculated. Results: Both Phi(ST) and Phi(CL) were significantly decreased in the LTN palsy group compared with the no palsy control group. The sensitivity and specificity for LTN palsy were 0.833 and 1.000 for Phi(ST) and 0.833 and 0.840 for Phi(CL), respectively, when the cutoff value was set as Phi(ST) = 15 degrees and Phi(CL) <= 24 degrees. Conclusion: Dynamic shrug radiographs provide a useful objective diagnosis of LTN palsy after traumatic BPI. (C) 2020 Published by Elsevier Inc. on behalf of Journal of Shoulder and Elbow Surgery Board of Trustees.