Poor midterm clinical outcomes and a high percentage of unsatisfying results are reported after seizure-related shoulder injuries, especially after posterior proximal humerus fracture-dislocations

Treating seizure-related shoulder injuries is challenging and an evidence-based consensus to guide clinicians is lacking. The aim of this prospective monocentric observational clinical trial was to evaluate the clinical results of a cohort of patients undergoing treatment of seizure-related shoulder injuries, to categorize them according to the lesions characteristics, with special focus on patients suffering proximal humerus fracture-dislocations (PHFD), and to define groups at risk of obtaining unsatisfactory results. We hypothesized that patients suffering a PHFD, considered the "worst-case-scenario" among these injuries, would report worse clinical results in terms of the quick Disabilities of the Arm, Shoulder and Hand questionnaire (qDASH) as compared to the other patients.Patients referred to a tertiary epilepsy center suffering from seizure-related shoulder injuries and with a minimum follow-up of one year were included. A quality-of-life assessment instrument (EQ-5D-5L), a district-specific patient reported outcome measure (qDASH) and a pain assessment tool (Visual Analogue Scale, VAS) were used for the clinical outcome evaluation. Subjective satisfaction and fear of new shoulder injuries was also documented. Categorization and subgroup analysis according to presence and features of selected specific lesions were performed.111 patients were deemed eligible and 83 were available for follow-up (median age 38 years, 30% females), accounting for a total of 107 injured shoulders. After a median follow-up of 3.9 [1.6 - 8.2] years, overall moderate clinical results were reported. 34.1% of the patients reported a VAS ≥ 35 mm, indicating moderate to severe pain and 34.1% a qDASH ≥ 40 points, indicating a severe disability of an upper limb. These percentage rose to 45.5% and 48.5% in the subgroup of patients suffering PHFD and to 68.8% and 68.8% in patients experiencing posterior PHFD. 46.9% of the patients considered themselves unsatisfied with the treatment and 62.5% reported a persistent fear of a new shoulder injury.Patients suffering from seizure-related shoulder injuries reported only moderate clinical results at their mid-term follow-up. Older age, male sex and absence or discontinuation of AED treatment were identified as characterizing features of patients suffering of posterior dislocation episodes. In patients suffering PHFD a tendency to worse clinical results was observed, with posterior PHFD patients emerging as a definite subgroup at risk of reporting unsatisfying results after treatment.