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Arterial abnormalities of the shoulder in athletes

Department of Orthopaedic Surgery

Walter J. McCarthy

Division of Vascular Surgery, Department of Surgery

James S.T. Yao

Division of Vascular Surgery, Department of Surgery

Michael F. Schafer

Department of Orthopaedic Surgery

Jacob R. Suker

Department of Medicine Northwestern University Medical School, Chicago, Illinois

Vascular lesions of the shoulder may be misinterpreted as one of the more familiar shoulder abnormalities by a treating physician. We are reporting on 13 athletes who were found to have symptoms related to compression of the subclavian or axillary artery or their tributaries. Nine were amateur or professional baseball pitchers. Severe arm fatigue or finger ischemia, secondary to embolization, were presenting symptoms. Arm fatigue was noted in all pitchers. After complete history and physical examination, including auscultation for bruits in functional positions, all athletes were evaluated by noninvasive tests (Doppler and Duplex scanning). Ar teriography was performed with positional testing, re creating overhead activity, and complete radiographic visualization of the dye to the digital arteries. Two patients were found to have subclavian artery aneu rysm. The remaining athletes were found to have compression of the subclavian artery beneath the an terior scalene muscle (five patients), the axillary artery beneath the pectoralis minor (two patients), both arterial segments (two patients), and one was found to have arterial compromise at the level of the humeral head. Branch artery compression was also noted. One pitcher occluded the posterior circumflex humeral artery with embolization to the digit.

The two patients with subclavian aneurysms under went saphenous vein bypass with cervical rib resection. All of the other athletes except one underwent resection of a 2 to 3 cm segment of the anterior scalene muscle or pectoralis minor muscles. All returned to their pre vious level of activity except one patient who developed impingement type symptoms and required acromio plasty. He is currently undergoing rehabilitation.

Proper recognition of vascular compromise in the upper extremity of athletes is essential to avoid the catastropic complications of arterial thrombosis.

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