Axillary artery laceration after anterior shoulder dislocation reduction

Abstract

Introduction Glenohumeral dislocation is the most commonly encountered dislocation in the emergency department. The most frequent complications of glenohumeral dislocation are rotator cuff tears and an increase in the risk of recurrent dislocation. Less common acute complications include fractures, neurological complications and vascular injuries. The incidence of axillary artery injury associated with shoulder dislocation is reported to be about 1–2%. Case An 81-year-old male presented to the emergency department with pain in the right shoulder after a fall. On physical examination, the shoulder was in slight abduction and external rotation. Shoulder movements were painful and there was a swelling in the axillary region which was tender to palpation. There was no sensory or motor deficit and the peripheral pulses were equal and palpable. Following the administration of analgesics, shoulder reduction was performed using the flexion-adduction-external rotation method. After reduction, the patient started complaining of axillary pain. On control examination, the patient did not have any motor or sensory deficits, but peripheral pulses were not palpable on the right arm. The right upper extremity computed tomography angiography, which was performed with the suspicion of vascular injury, revealed a right axillary artery rupture. Conclusion Axillary artery injury accompanying anterior shoulder dislocation is a rare but serious condition which may result in limb loss and death.

Hemodynamic Instability After Axillary Artery Rupture Following Inferior Glenohumeral Joint Dislocation: A Case Report

“…The use of diagnostic modalities such as CT scan with contrast or arteriogram should be performed with a low threshold of suspicion. The literature on axillary artery injury caused by inferior or anterior shoulder dislocation suggests that 1 or more of the following symptoms after reduction should lead to considerations of utilizing further diagnostic modalities: enlarging hematoma in the right axilla, diminished radial and ulnar pulse [ 14 ], sudden increase in pain from the shoulder/axilla [ 8 ], and or hemodynamic instability, as in our patient. The threshold of suspicion should be even lower if the patient has a medical history of recurrent shoulder dislocations, arthro-sclerosis [ 8 ] or age above 60 years old [ 16 ].…”

“…In our case, the debut of axillary artery injury presented when the patient showed signs of hemodynamic instability together with clinical suspicion of an enlarging hematoma in the right axilla 6 hours after reduction. Eyler et al has reported that signs of an enlarging haematoma and diminished radial pulse following anterior shoulder dislocation are characteristic of axillary artery injury [ 14 ].…”

Fatal Outcome After Reduction of a Superior Shoulder Dislocation, A Case Report and Literature Review

“…History of recurrent dislocations has been reported in up to one-third of the patients 5,18,19 . The type of vascular injury varies between subtle intimal tears and complete vascular lacerations 18,20,21 . The most commonly injured site is the third portion of the axillary artery; however, circumflex, subscapular arteries and axillary vein lacerations have also been described 11 .…”

“…High clinical suspicion is essential before and after reduction especially in elderly patients and a history of previous dislocations. Symptoms may include a triad of shoulder dislocation, protruding axillary hematoma, and absent or diminished distal pulses 4,18,21 . However, in some cases as our patient, good peripheral capillary filling, temperature, and palpable pulses may persist even after arterial injury because of the collateral irrigation of the arm; for this reason, pulses do not exclude arterial injury.…”

“…The majority of these injuries occur in elderly patients; about 90% of the reported cases are older than 50 years. History of recurrent dislocations has been reported in up to one-third of the patients 5,18,19 . The type of vascular injury varies between subtle intimal tears and complete vascular lacerations 18,20,21 .…”