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Abstract:
Injury to the axillary artery as a
complication of anterior shoulder joint dislocation is a well
known entity. The severity may vary from simple intimal tear to
complete transaction of the artery with or with out involvement
of the brachial plexus. We report an elderly lady who presented
with cold right hand, parasthesia and absent radial pulse two
days after shoulder joint reduction. Arteriogram done showed
complete cut off at the third part of the axillary artery.
Exploration of axillary artery revealed entrapment of the artery
with in the joint. The axillary artery dissected from the
joint. Artery had thrombus inside. Resection and a long
saphenous vein interposition graft was done. Patient did good
post operative recovery. Follow up done a month later revealed
full range of shoulder movements and good wrist pulse.
J.Orthopaedics 2007;4(4)e10
Case Report :
A 77 year old lady, right handed presented to
us with cold right hand and parasthesia. She gave a history of
right shoulder joint dislocation (first episode) two days back
with no neurovascular deficit or associated fracture. This was
manipulated and reduced under anaesthesia without obvious
complication and discharged home the same day. There were no
associated co-morbid conditions.
Examination done revealed absent brachial
and radial pluses. Except for mild sensory loss along
distribution of median nerve there was no neurological deficit.
A Doppler scan, confirmed showed complete absence of brachial
arterial signals (fig 1).Later an arteriogram was performed,
this showed abrupt cut-off of the axillary artery at the third
part (fig 2).
Decision was made to explore the axillary
artery. On Exploration, a tear was found in the anterior joint
capsule and the axillary artery was actually entrapped with in
the joint (fig 3). The entrapped artery was removed from the
joint .Artery was full of thrombus. Artery was resected and a
long saphenous vein interposition graft was done along with
distal embolectomy. Post op recovery was uneventful. On follow
up done a month later, patient had full range of shoulder joint
movements with good wrist pulse.
Fig.1
Fig.2
Fig.3
Discussion :
: Anterior dislocation of the shoulder joint
is the commonest form of shoulder dislocation. Vascular
complications following shoulder joint dislocation are rare
1 .There are case reports on axillary artery injury
depending on severity following dislocation. A multicenter, 5
year retrospective study done by Sparks et al showed
arterial injury seen in 0.74% of patients in simple upper
extremity dislocations, amongst this axillary artery injury was
in 0.97.% and brachial artery injury was in 0.47% of patients
2.Review of 22 reported cases of arterial injury by
Gates JD et al showed that 86% of the patients were above
50 years and 86% had injury in the third part of the axillary
artery 3.This implies that axillary artery injury is
seen more commonly in elderly, common site being third part.
Psedoaneurysm following shoulder joint dislocation has also been
reported 4.There are case reports on injury to the
brachial plexus due to the dislocation.
All of these injuries are following shoulder
joint dislocation. It is extremely rare to have the axillary
artery injury after an uncomplicated closed shoulder joint
reduction. A literature search revealed only one such case
report on axillary artery entrapment after shoulder joint
reduction 5.
Reconstruction of the artery can be done by
either an autograft or a prosthetic material. These patients
require regular follow up for the surveillance of the graft.
Conclusion:
Axillary artery injury following shoulder
joint dislocation is rare.It is more commonly seen in elderly
patients. Third part of the axillary artery is commonly
involved. Injury to the axillary artery following reduction can
occur. Check neurovascular status even after the reduction of
the shoulder joint.
References :
1.Drury JK, Scullion JE.Vascular
complications of anterior dislocation of the shoulder Br J Surg.
1980 Aug;67(8):579-81.
2. Sparks SR, DeLaRosa J, Bergan JJ, Hoyt DB,
Owens EL. Arterial injury in uncomplicated upper extremity
dislocations. Ann Vasc Surg. 2000 Mar;14(2):110-3
3. Gates JD, Knox JB.. Axillary artery
injuries secondary to anterior dislocation of the shoulder. J
Trauma. 1995 Sep;39(3):581-3
4. Julia J, Lozano P, Gomez F, Corominas C.
Traumatic pseudoaneurysm of the axillary artery following
anterior dislocation of the shoulder. Case report. J Cardiovasc
Surg (Torino). 1998 Apr;39(2):167-9
5. Fraioli JP, Farge C, Cahuzac J, Cohen-Boulakia
A, Turpin P. The imprisoning of the axillary artery between the
head of the humerus and the anterior edge of the glenoid cavity.
An unusual vascular complication of shoulder dislocation. One
case. Ann Chir. 1982 May;36(5):378-80
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