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CASE REPORT

Entrapment Of Axillary Artery In Shoulder Joint After Anterior Shoulder Joint Reduction: A Case Report

 Kattepura S  *,Krishnamurthy S *,  Halliday M**

* Department of Orthopaedics
**Consultant Vascular Surgeon
The Princess Royal Hospital,Telford TF1 6TF

Address for Correspondence:

Mr S Kattepura MS, DNB, MRCS(ED), Mch
The Princess Royal Hospital

Telford TF1 6TF

E mail:drsubbak@yahoo.com

 

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

 

This is a peer reviewed paper 

Please cite as : Kattepura S : Entrapment Of Axillary Artery In Shoulder Joint After Anterior Shoulder Joint Reduction: A Case Report

J.Orthopaedics 2007;4(4)e10

URL: http://www.jortho.org/2007/4/1/e16

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