Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.Neurological complications following shoulder arthroplasty have historically received little attention in the literature. Various reports have shown that the rate of clinically identifiable nerve injury ranges from 0.6% to 7.6%. In a recent study in which intraoperative neuromonitoring was used, the incidence of intraoperative nerve dysfunction was 56.7%, with a statistically higher rate in patients with less than 10° of external rotation and a history of open surgery. Currently, we are using intraoperative nerve monitoring to help prevent nerve injury during shoulder arthroplasty. Concurrently, we are trying to identify the incidence, pattern, and predisposing factors for these injuries. In this video, we present the nerve monitoring technique we use during shoulder arthroplasty. Room and neuromonitoring setup, patient positioning, anesthesia considerations, and intraoperative practices are included. Additionally, were view our outcomes of 134 shoulders in 121 patients who underwent continuous intraoperative monitoring during shoulder arthroplasty. The results of our research show that transcranial motor evoked potentials are timely and sensitive indicators of impending iatrogenic nerve injury during shoulder arthroplasty. To minimize the risk for clinically relevant postoperative nerve injury, persistent signal amplitude reduction greater than 80% in multiple muscle groups should be avoided.