Axillary artery laceration after anterior shoulder dislocation reduction

Yesim Eyler; Turgay Yılmaz Kilic; Ali Turgut; Onur Hakoglu; Hasan Idil

doi:10.1016/j.tjem.2018.10.004

Yesim Eyler¹, Turgay Yılmaz Kilic¹, Ali Turgut², Onur Hakoglu¹, Hasan Idil¹

¹Attending Physician of Emergency Medicine, Department of Emergency Medicine, Tepecik Training and Research Hospital, Izmir, Turkey
²Attending Physician of Orthopedics and Traumatology, Department of Orthopedics and Traumatology, Tepecik Training and Research Hospital, Izmir, Turkey

Keywords: Shoulder dislocation, Axillary artery injury, Reduction, Emergency department

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.