Abstract
Introduction Axillary artery injury in the shoulder region following blunt trauma without association
with either shoulder dislocation or fracture of the humeral neck has been previously
reported. Axillary artery injury might also be accompanied with brachial plexus injury.
However, delayed onset of brachial plexus palsy caused by a compressive hematoma associated
with axillary injury after blunt trauma in the shoulder region has been rarely reported.
In previous reports, this condition only occurred in old patients with sclerotic vessels.
We present a case of a young patient who suffered axillary artery injury associated
with brachial plexus palsy that occurred tardily due to compressive hematoma after
blunt trauma in the shoulder region without association of either shoulder dislocation
or humeral neck fracture.
Case presentation A 16-year-old male injured his right shoulder in a motorbike accident. On initial
physical evaluation, the pulses on the radial and ulnar arteries in the affected arm
were palpable. Paralysis developed later from 2 days after the injury. Functions in
the right arm became significantly impaired. Angiography showed complete occlusion
of the axillary artery. Magnetic resonance imaging demonstrated a mass measuring 4
× 5 cm that was suspected to be a hematoma compressing the brachial plexus in a space
between the subscapular muscle and the pectoralis minor muscle. Surgery was performed
on the third day after injury. In intraoperative observations, the axillary artery
was occluded with thrombus along 5 cm; a subscapular artery was ruptured; the brachial
plexus was compressed by the hematoma. After evacuation of the hematoma, neurolysis
of the brachial plexus, and revascularization of the axillary artery, the patient
had an excellent functional recovery of the affected upper limb, postoperatively.
Conclusion Surgeons should be aware that axillary artery injuries may even occur in young people
after severe blunt trauma in the shoulder region and can be associated with secondary
brachial plexus injury due to a hematoma. For treatment in cases with progressive
nervous deficit after trauma, not only reconstruction of the injured artery but also
immediate evacuation of the hematoma, and exploration of the brachial plexus are necessary
to avoid irreversible neurological damage.
