Volume 13, Issue 2 (Spring- In press 2026)
JROS 2026, 13(2): 0-0 |
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Tabrizian P, Nakhaei Amroodi M, Bahaeddini M, Hashemipour B, Safaei F, Khajeh Alizadeh Attar M et al . Clinical Outcomes of Concomitant Shoulder Dislocation, Rotator Cuff Tear, and Axillary Nerve Injury: A 14-year Retrospective Study. JROS 2026; 13 (2)
URL: http://jros.iums.ac.ir/article-1-2321-en.html
URL: http://jros.iums.ac.ir/article-1-2321-en.html
Pouria Tabrizian1 
, Morteza Nakhaei Amroodi1 , Mohammadreza Bahaeddini1 , Babak Hashemipour1 , Fateme Safaei1 , Mojtaba Khajeh Alizadeh Attar1 , Mohammadmehdi Mahdavifar1
, Morteza Nakhaei Amroodi1 , Mohammadreza Bahaeddini1 , Babak Hashemipour1 , Fateme Safaei1 , Mojtaba Khajeh Alizadeh Attar1 , Mohammadmehdi Mahdavifar1
1- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Abstract: (1 Views)
Background and Objective: The so-called terrible triad of the shoulder—defined by the anterior shoulder dislocation, associated with rotator cuff tear, and axillary nerve injury—represents a rare but debilitating injury pattern. Due to its multifactorial nature, it poses significant challenges in diagnosis, treatment, and functional recovery. This study aimed to evaluate clinical and functional outcomes and identify factors influencing recovery in affected patients.
Methods: This retrospective cohort study included 50 patients diagnosed with the terrible triad of the shoulder between 2011 and 2024. The outcomes included pain severity (Visual Analog Scale), fatigue (Fatigue Severity Scale), and shoulder range of motion (ROM) at 6 and 18 months. Nerve recovery was assessed clinically and via electromyography (EMG). Associations between demographic variables and outcomes were analyzed using appropriate statistical tests.
Results: The mean age of patients was 54.14 ± 8.58 years, and 66% were male. Complete nerve recovery was observed in 36% of patients, partial recovery in 40%, and no recovery in 24%. Electromyography (EMG) findings confirmed improvement in 92% of cases. Shoulder ROM improved significantly from 49.98 ± 7.96° at 6 months to 62.32 ± 11.62° at 18 months (P < 0.001). The mean pain score was 3.32 ± 1.47, and the mean fatigue score was 67.86 ± 11.11. Increasing age was significantly associated with reduced ROM (r = -0.613, P < 0.001) and higher pain levels (r = 0.434, P = 0.002). Male patients demonstrated better ROM at both 6 months (P = 0.005) and 18 months (P = 0.001), as well as higher rates of complete nerve recovery (P = 0.015), but reported greater fatigue (P < 0.001). Female patients experienced higher pain levels (P < 0.001).
Conclusion: Older age and female sex are associated with poorer functional outcomes following upper limb nerve injuries. These findings support the presence of a pain–fatigue–limited mobility cycle. Early, personalized, and multidisciplinary strategies are essential to optimize recovery outcomes.
Methods: This retrospective cohort study included 50 patients diagnosed with the terrible triad of the shoulder between 2011 and 2024. The outcomes included pain severity (Visual Analog Scale), fatigue (Fatigue Severity Scale), and shoulder range of motion (ROM) at 6 and 18 months. Nerve recovery was assessed clinically and via electromyography (EMG). Associations between demographic variables and outcomes were analyzed using appropriate statistical tests.
Results: The mean age of patients was 54.14 ± 8.58 years, and 66% were male. Complete nerve recovery was observed in 36% of patients, partial recovery in 40%, and no recovery in 24%. Electromyography (EMG) findings confirmed improvement in 92% of cases. Shoulder ROM improved significantly from 49.98 ± 7.96° at 6 months to 62.32 ± 11.62° at 18 months (P < 0.001). The mean pain score was 3.32 ± 1.47, and the mean fatigue score was 67.86 ± 11.11. Increasing age was significantly associated with reduced ROM (r = -0.613, P < 0.001) and higher pain levels (r = 0.434, P = 0.002). Male patients demonstrated better ROM at both 6 months (P = 0.005) and 18 months (P = 0.001), as well as higher rates of complete nerve recovery (P = 0.015), but reported greater fatigue (P < 0.001). Female patients experienced higher pain levels (P < 0.001).
Conclusion: Older age and female sex are associated with poorer functional outcomes following upper limb nerve injuries. These findings support the presence of a pain–fatigue–limited mobility cycle. Early, personalized, and multidisciplinary strategies are essential to optimize recovery outcomes.
Keywords: Terrible triad of the shoulder, Shoulder dislocation, Rotator cuff tear, Axillary nerve injury, Functional outcome, Range of motion (ROM), Electromyography (EMG)
Type of Study: Research Article |
Subject:
Shoulder / Elbow
Received: 2026/05/3 | Accepted: 2026/05/4 | Published: 2026/07/19
Received: 2026/05/3 | Accepted: 2026/05/4 | Published: 2026/07/19
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