Rupture of the axillary (circumflex) nerve and artery in a champion jockey: Figure 1

Abstract

Rupture of the circumflex artery and nerve, without fracture or dislocation, is a rare traumatic event. Such a case is reported in a champion flat jockey who sustained blunt trauma to the shoulder after a fall during a race; the literature is also reviewed. At urgent surgical exploration, the axillary artery and nerve were repaired. The patient subsequently successfully returned to professional riding. This case highlights the diYculties in diagnosis and management. (Br J Sports Med 2001;35:361-363)

Axillary artery and brachial plexus injury secondary to blunt trauma

“…Brachial plexus injury secondary to shoulder trauma usually results in neuropraxia or axonotmesis and rarely requires any surgical treatment, with improvement usually within 3–6 months [ 4 , 5 ]. However, if nerve rupture is diagnosed, the outcome is far superior if repaired early than late as the denervated muscle becomes fibrotic and functional outcome may remain poor [ 2 ]. Neurological investigations are not helpful initially as nerve conduction and electromyography studies may be normal in the acute setting and will not show decreased conduction for 7–10 days [ 2 , 7 ].…”

“…However, if nerve rupture is diagnosed, the outcome is far superior if repaired early than late as the denervated muscle becomes fibrotic and functional outcome may remain poor [ 2 ]. Neurological investigations are not helpful initially as nerve conduction and electromyography studies may be normal in the acute setting and will not show decreased conduction for 7–10 days [ 2 , 7 ]. Therefore, a high index of suspicion for significant injury must exist in high velocity trauma with abnormal neurological findings on examination.…”

“…Rupture of the axillary artery is a rare traumatic event and is usually associated with either anterior shoulder dislocation or proximal humerus fracture [ 1 , 2 ]. A brachial plexus injury may occur during a forceful stretch of the arm or direct impact to the axilla, but a combined axillary artery and brachial plexus injury has rarely been reported in the literature.…”

Axillo-subclavian dissection and pseudoaneurysm following inferior glenohumeral dislocation: Case report and literature review

“…Patients with multiple prior dislocations should be evaluated more judiciously for these rare injuries. Sports-related glenohumeral dislocations (ice hockey, thoroughbred horse riding, baseball, volleyball, and cycling) place patients at higher risk for axillo-subclavian complications [[12], [13], [14]]. Shoulder dislocations in patients over the age of fifty also have higher likelihood of vascular compromise.…”

Axillary nerve palsy consequent to a guided manual stretch of the upper extremities: a case report

“…It is noteworthy that extreme traction can lead not only to a tear of some AN fibers, but also to a complete rupture of the nerve and the accompanying circumflex artery. 7 Even the nerve fibers for the teres minor muscle can be affected as a result of this type of traction injury. 8 Other traumatic mechanisms of blunt trauma to the AN involve penetrating injuries, subluxation or fracture.…”