[Soft tissue injuries of the shoulder joint]

In contrast to rare occurrence of blood vessel and nerve injuries the frequency of tendinous lesions of the shoulder is high. The clinical diagnosis of the ruptured tendon of the M. biceps brachii is obvious. On the other hand only arthrography or arthroscopy can verify the diagnosis of a ruptured supraspinatus tendon. The best access for tenosuture and tenoplasty of the latter is the transacromeal method.

Traumatic pseudoaneurysm of the axillary artery: report of three cases and literature review

Three cases of pseudoaneurysm of the axillary artery resulting from blunt or penetrating trauma to the shoulder are reported. Delayed recognition led to compression neuropathies of the brachial plexus. Despite adequate vascular repair of the axillary artery all three patients had permanent neurologic deficits. Therefore brachial plexus palsy occurring after blunt or penetrating shoulder trauma should alert the clinician to investigate the vascular supply of the arm.

Axillary artery rupture caused by shoulder dislocation

A case of axillary artery disruption following an anterior shoulder dislocation is reported, the eleventh such case in the past 25 years. As an alternative to dividing the pectoralis major tendon, two incisions, infraclavicular and transaxillary incisions, were used to repair the artery with an interposition Dacron graft. An absent radial pulse following a shoulder dislocation suggests the possibility of axillary artery injury, usually a dissected intimal flap but occasionally a ruptured vessel. Early arterial repair is indicated, preceded by arteriography, if available. Brachial plexus injury frequently accompanies arterial damage and is not affected by arterial repair. Permanent, partial motor dysfunction is common, especially involving the extensors of the hand.

Axillary artery disruption secondary to anterior dislocation of the shoulder

We report a 13-year-old male who sustained a segmental injury to the third part of the left axillary artery following a subcoracoid shoulder dislocation while wrestling. The artery was repaired with an autogenous saphenous vein interposition graft. The patient's postoperative course was uneventful, and, in a 3-year followup, he has complete range of motion of the left shoulder without neurovascular compromise.

Amputations after vascular trauma in civilians

In a ten-year retrospective study of 233 patients who sustained a vascular injury to an extremity, eight (3.4%) extremities were amputated. Factors that affect the incidence of amputation after peripheral vascular trauma include early operation, fasciotomy, preoperative antibiotics, appropriate vascular reconstruction with adequate tissue coverage, use of arteriography during and after reconstruction, and early reoperation for postoperative complications. Some patients benefit psychologically and physically from early definitive amputation.

Anterior glenohumeral instability

Anterior glenohumeral instability is an important cause of shoulder disability in athletes. Recurrent glenohumeral instability can seriously impair the athlete's performance. Since the surgical repair of recurrent instability may result in a loss of flexibility, particularly in the thrower and gymnast, the physician must optimize both joint stability and joint flexibility.

Axillary artery injury with minimally displaced fracture of the neck of the humerus

A case of axillary artery injury resulting from a minimally displaced fracture of the neck of the humerus is reported. Very few such injuries have been reported previously. The mechanism of injury can be from sharp bony fragments, overstretching of the artery especially when atheromatous, or torn intima. Angiography should be performed, followed by exploration where indicated.

[Injuries of the major blood vessels in joint dislocations]

Experience with the treatment of 12 patients with injuries of major vessels resulting from dislocations of joints is generalized. In 5 of the patients an associated injury of nerve trunks was diagnosed, in 4 patients there were injuries of major veins. Reconstructive operations were made in 11 patients. In 8 patients full recovery was stated, three patients were subjected to amputation of the extremity. The main cause of the failure was late diagnosis of the closed trauma of the artery and progressing ischemia of the extremity.

Vascular injuries of the axilla

Between January 1970 and December 1980, 65 patients sustaining 85 vascular injuries of the axillary artery and/or vein were managed at the Ben Taub General Hospital in Houston, Texas. Concomitant injuries of the subclavian and/or brachial vessels were noted in 34 per cent of patients. A variety of exposure techniques was used in approaching the axillary vessels. Emphasis upon preservation of collateral vessels led to an increased use of substitute vascular conduits over end-to-end anastomosis. The ready availability of prosthetic conduits, absence of graft infection, and excellent short-term patency have made them a primary choice for axillary arterial reconstruction in our recent experience. Associated brachial plexus injury (35%) accounted for the most significant long-term morbidity. The operative mortality was 3.1%, and one patient required upper extremity amputation following failure of repeated revascularization attempts.

Neurovascular traction injuries of the upper limb root

Eight cases of injury to the subclavian and axillary arteries are described. All were accompanied by injury to the brachial plexus. Arterial continuity was restored in all cases. Six young patients sustained high velocity injuries and they showed no neurological improvement. Two elderly patients with low velocity injuries recovered neurological function in the limb. Primary amputation should be considered when nerve damage is obviously very severe.

Axillary artery injury in erect dislocation of the shoulder

Two rare event occurred in one patient: luxation erecta, an unusual form of dislocation at the shoulder, and axillary artery injury, hitherto undescribed in this type of dislocation. The arterial injury consisted of rupture of the intima with secondary thrombosis and occlusion. Following resection of the contused artery and saphenous vein graft replacement normal circulation was restored.

Brachial plexus compression: complication of delayed recognition of arterial injuries of the shoulder girdle

In six cases of penetrating trauma to the subclavian or axillary arteries without primary coincident injury to the brachial plexus, the vascular injury was not initially recognized as there were no suggestive clinical signs. The first clinical sign of vascular injury in all cases was delayed onset of brachial plexus palsy due to compression by an expanding false aneurysm. Following vascular repair, neurological recovery occurred only in two of six cases. Since brachial plexus injuries are associated with a poor prognosis, and the functional impairment of the upper extremity is serious, an aggressive investigative approach to all penetrating shoulder girdle injuries is advocated. Arteriography should be considered, even when suggestive clinical signs of vascular injury are absent. Even relatively small false aneurysms should be repaired without delay before the onset of neurological symptoms.

Arterial injuries of the extremities following blunt trauma

Thirty-three peripheral arterial injuries were observed in 29 patients following blunt trauma. Motor vehicle accidents were the most common initiating event. The mechanism of injury was fracture or dislocation in 21 patients, acute traction on the extremity in five patients, and contusion in three patients. Pulses were absent distal to the site of arterial injury in all patients. Complete arterial disruption was documented in 19 arteries; intimal or intimal and medial tears were observed in 10 arteries. Four arteries not surgically explored. If possible, debridement and primary anastomosis was the preferred method of revascularization. Saphenous vein interposition grafts were the second choice. Five amputations, four major and one minor, were required. Although patient vascular reconstructions may be uniformly achieved, long-term functional results are frequently affected by the duration of limb ischemia before revascularization, and concomitant injuries to bone, nerve, and soft tissue.

Combined brachial, axillary, and subclavian artery injuries of the same extremity

Review of a case involving simultaneous management of injuries to the brachial, axillary, and subclavian arteries stresses the need for arteriography in suspected subclavian injuries and the need for knowledge of the operative exposures available to the operating surgeon.

Vascular complications of anterior dislocation of the shoulder

Vascular complications are rare in cases of simple anterior dislocation of the shoulder but the axillary artery and its branches may be damaged. Four cases of axillary artery injury, including 2 cases of complete transection of the artery, are presented. Full upper limb function may return if the vascular damage is recognized and prompt surgical treatment undertaken.

Arterial surgery for arm ischemia. A survey of 136 patients

A series of 136 patients with upper extremity ischemia requiring operative correction is presented. Causes of the ischemia included trauma, atherosclerosis, embolism, iatrogenic causes, radiation injury, and cervical rib syndrome. Operations included primary repair, various bypass grafts and embolectomy. Illustrative case reports are used to emphasize important points. The subclavian, axillary and brachial arteries have been considered separately. In general, ischemia of the arm caused by a discrete lesion is amenable to surgical correction with an excellent change of success.