Intraoperative nerve injuries during orthopaedic shoulder procedures can cause pain, paresthesia, and muscle weakness. Iatrogenic nerve injuries are often transient or subclinical, and it is believed that many neurologic injuries go undiagnosed. Several risk factors predispose patients to intraoperative nerve injury, including local tissue stiffness, revision surgery, low body mass index, medications, and decreased range of motion. Apart from patient-specific risk factors, there are direct and indirect mechanisms of injury related to surgical technique, including device implantation, nerve traction, patient positioning, retractor placement, and portal placement. Cadaveric, clinical, and intraoperative neuromonitoring studies have advanced our understanding of surgical anatomy and intraoperative mechanisms underlying nerve injuries during shoulder surgery. The primary purpose of this article is to review the neurologic complications during common open and arthroscopic shoulder procedures. This review will detail the neuroanatomic proximities around the shoulder, as well as provide recommendations from the literature on avoiding nerve injury.

Dissipation of body heat, essential to human life, is largely achieved through sweating. If sweating does not occur normally-as in patients with hypohidrosis (reduced sweating) or anhidrosis (lack of sweating)-the ability to dissipate heat via evaporative mechanisms is overwhelmed. Body temperature may rise, leading to heat-related illness, including heat intolerance, hyperthermia, heat exhaustion, heat stroke, and even death. In patients seen by a dermatologist, anhidrosis may underly and contribute to their symptoms and signs but may be difficult to detect given a limited availability of tools to measure anhidrosis. An association between anhidrosis and skin symptoms including flushing syndromes (eg, facial flushing and erythromelalgia) and widespread skin symptoms (eg, itching, burning, numbness, or tingling, and paresthesias) has recently been described. This review explores the existing dermatologic literature on anhidrosis including clues to the pathophysiology of these disorders, its relationship to skin diseases and symptoms, the tests currently available, and approaches to management. Recognition of an underlying anhidrosis by dermatologists may be important for providing optimal management for patients with heat-related symptoms.

Pontine and brainstem tumors during pregnancy are rare. However, they carry a high maternal mortality risk due to symptom overlap with common pregnancy-related conditions. Diagnosis and management are often delayed and remain challenging. This study presented two cases of pregnant patients with brainstem tumors. The first case involved an 18-week pregnant woman presenting with otitis-like symptoms, facial palsy, right-sided paresthesia, and paralysis. By the time a definitive diagnosis was established, the tumor had become inoperable, and the patient died from tumor-related complications. The second case involved a 23-week pregnant woman who presented with headache, nausea, vomiting, dysphagia, and significant weight loss. The pregnancy ended shortly after admission due to preterm premature rupture of membranes, and the patient subsequently died following tumor resection as a result of massive intracranial hemorrhage. These cases highlighted the high risk of misdiagnosis due to overlap with common pregnancy-related symptoms and highlighted the importance of early neurological evaluation to ensure accurate diagnosis and timely management.

The occurrence of mesenchymal tumor, FET::CREB fusion-positive in the spinal compartment is exceptionally rare, with only a few previously documented cases. Here, we present a unique case of a 43-year-old man who developed a mesenchymal tumor, FET::CREB fusion-positive at the T1 spinal level. Clinically, the patient reported chronic posterior neck and shoulder pain accompanied by the intermittent paresthesia of the right arm. Magnetic resonance imaging demonstrated an intradural extramedullary mass, initially suggestive of a schwannoma. The patient underwent near-total surgical removal via a right C7-T1 hemilaminectomy. Histological examination revealed epithelioid and cord-like cellular arrangements within a mixed sclerotic and myxochondroid stroma. Immunohistochemistry revealed partial positivity for epithelial membrane antigen (EMA), smooth muscle actin (SMA), and CD99. Molecular analysis confirmed the presence of EWSR1::CREM fusion, establishing the diagnosis of a mesenchymal tumor, FET::CREB fusion-positive. To date, all reported spinal mesenchymal tumors within this molecular category have exclusively featured CREM as an FET gene family fusion partner, thereby highlighting a potential site-specific molecular signature. In this case report, we discuss the potential diagnostic challenges, characteristic pathological spectra, and clinical considerations associated with this rare entity of the spine.

Trigeminal trophic syndrome (TTS) is a rare neurocutaneous disorder defined by trigeminal anesthesia, facial paresthesia, and crescentic ulceration of the nasal ala. We describe an 86-year-old woman with long-standing trigeminal neuralgia who developed a suspicious ulcerated lesion on the left nasal ala. Although the initial biopsy showed atypical squamous cells suggestive of squamous cell carcinoma, the combined histopathologic, radiologic, and clinical findings supported a diagnosis of TTS. This case underscores the need to distinguish TTS from malignancy, particularly in elderly patients with neurologic comorbidities. Early recognition may prevent unnecessary invasive procedures and improve outcomes.