Axillary artery injury combined with delayed brachial plexus palsy due to compressive hematoma in a young patient: a case report

Delayed Onset of Subclavian Artery Pseudoaneurysm With Brachial Plexus Compression Following Gunshot Wound Injury

Early diagnosis of brachial plexus injuries is crucial to prevent long-term morbidity and improve outcomes. We present a unique case of delayed onset of brachial plexus compression two months following a traumatic gunshot injury causing multiple injuries including a T1 vertebral body comminuted fracture and pneumothorax. The patient experienced significant pain and progressive neurological examination changes during follow-up visits, and thus duplex ultrasound and computed tomography (CT) angiography were performed, which demonstrated a left subclavian artery pseudoaneurysm. This was managed operatively by evacuation and interposition bypass. Injuries to the cervical and upper thoracic spine are complex, and when patients present with new-onset neurological findings, axillary swelling, or significant uncontrolled postoperative pain, secondary complications should be suspected. Patients at a high risk of vascular reinjury should be routinely monitored at follow-up to prevent the development of progressive neurological damage to the brachial plexus.

Axillary artery and brachial plexus injury secondary to blunt trauma

Rupture of the axillary artery after blunt trauma is an unusual injury, typically occurring in association with anterior dislocation of the shoulder or fracture-dislocation of the surgical head of the humerus. An associated blunt brachial plexus injury will typically accompany such an injury due to its intimate anatomical juxtaposition. We present the case of an elderly female, who presented after a fall from height, onto the outstretched arm, sustaining a combined axillary artery and brachial plexus blunt injury. The patient in this case recovered well post-operatively. The challenge in cases such as this is timely diagnosis and management of the vascular injury. The mechanism of injury combined with the presence or absence of hard signs of vascular injury should alert the clinician with rapid transition to investigation and management where appropriate, to minimise the warm ischaemic time to the upper limb and / or control of haemorrhage. Blunt injuries to the brachial plexus often require a prolonged period of time before accurate recovery can be prognosticated for.

Brachial plexus injury after shoulder dislocation: a literature review

Brachial plexus injuries are among the rarest but at the same time the most severe complications of shoulder dislocation. The symptoms range from transient weakening or tingling sensation of the upper limb to total permanent paralysis of the limb associated with chronic pain and disability. Conflicting opinions exist as to whether these injuries should be treated operatively and if so when surgery should be performed. In this review, available literature dedicated to neurological complications of shoulder dislocation has been analysed and management algorithm has been proposed. Neurological complications were found in 5.4-55% of all dislocations, with the two most commonly affected patient groups being elderly women sustaining dislocation as a result of a simple fall and young men after high-energy injuries, often multitrauma victims. Infraclavicular part of the brachial plexus was most often affected. Neurapraxia or axonotmesis predominated, and complete nerve disruption was observed in less than 3% of the patients. Shoulder dislocation caused injury to multiple nerves more often than mononeuropathies. The axillary nerve was most commonly affected, both as a single nerve and in combination with other nerves. Older patient age, higher energy of the initial trauma and longer period from dislocation to its reduction have been postulated as risk factors. Brachial plexus injury resolved spontaneously in the majority of the patients. Operative treatment was required in 13-18% of the patients in different studies. Patients with suspected neurological complications require systematic control. Surgery should be performed within 3-6 months from the injury when no signs of recovery are present.

[Paresis of the brachial plexus after anterior shoulder luxation : Traumatic damage or compression due to hematoma?]

After traumatic anterior shoulder dislocation and self-reduction, the patient initially showed an inconspicuous clinical course. At the time of presentation in the emergency room the upper limb neurological status was reported to be normal. After discharge, paresis of the brachial plexus of the left arm occurred within 8 h. A subsequently performed computed tomography (CT) scan revealed a hematoma close to the brachial plexus, which was treated by surgical decompression and resulted in symptom relief. This case report describes a rare but significant complication after anterior shoulder dislocation, which should not be underestimated in the setting of a surgical emergency admission.