title: Anterior humeral circumflex artery avulsion with brachial plexus injury following an isolated traumatic anterior shoulder dislocation.
abstract: A 70-year-old man presented to accident and emergency with an isolated anteriorly dislocated shoulder, in the absence of a concomitant fracture. There was no neurovascular deficit at presentation, and the shoulder was reduced under sedation, using the Kocher's technique. Following this, the patient developed signs of hypovolaemic shock. Clinical examination revealed an expanding fullness in the deltopectoral area, with compromise of the limb neurovascular status. CT imaging confirmed an expanding haematoma from the axillary vessels, restricting left lung expansion. Once resuscitated, the patient was transferred to theatre for exploration of the bleeding vessels. Intraoperative findings included an avulsed anterior circumflex humeral artery that was subsequently ligated. Postoperatively, the patient developed axillary, radial, median and ulnar nerve neuropraxia, which improved clinically prior to discharge. The patient was ultimately discharged home after a lengthy inpatient stay.
authors.affiliation: Department of Trauma & Orthopaedics, Kettering General Hospital, Kettering, UK.
authors.forename: Rohi
authors.initials: R
authors.lastname: Shah
authors.affiliation: UHL, Leicester Royal Infirmary, Leicester, UK.
authors.forename: Jacob
authors.initials: J
authors.lastname: Koris
authors.affiliation: Department of Trauma & Orthopaedics, Kettering General Hospital, Kettering, UK.
authors.forename: Akhlaq
authors.initials: A
authors.lastname: Wazir
authors.affiliation: Department of Trauma & Orthopaedics, Kettering General Hospital, Kettering, UK.
authors.forename: Shyamsundar S
authors.initials: SS
authors.lastname: Srinivasan
mesh_terms: D000368:Aged; D001158:Arteries; D001366:Axillary Artery / Q000293:injuries / Q000601:surgery; D001917:Brachial Plexus / Q000293:injuries*; D005440:Fluid Therapy; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D006811:Humerus / Q000098:blood supply*; D008297:Male; D012769:Shock / Q000628:therapy; D012783:Shoulder Dislocation / Q000150:complications* / Q000000981:diagnostic imaging