Eyler Yesim, Yılmaz Kilic Turgay, Turgut Ali, Hakoglu Onur, Idil Hasan
Attending Physician of Emergency Medicine, Department of Emergency Medicine, Tepecik Training and Research Hospital, Izmir, Turkey.
Attending Physician of Orthopedics and Traumatology, Department of Orthopedics and Traumatology, Tepecik Training and Research Hospital, Izmir, Turkey.
Turk J Emerg Med. 2018 Nov 9;19(2):87-89. doi: 10.1016/j.tjem.2018.10.004. eCollection 2019 Apr.
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%.
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.
Axillary artery injury accompanying anterior shoulder dislocation is a rare but serious condition which may result in limb loss and death.
肩关节脱位是急诊科最常见的脱位类型。肩关节脱位最常见的并发症是肩袖撕裂以及复发性脱位风险增加。较不常见的急性并发症包括骨折、神经并发症和血管损伤。据报道，与肩关节脱位相关的腋动脉损伤发生率约为1%至2%。
一名81岁男性因跌倒后右肩疼痛就诊于急诊科。体格检查时，肩部处于轻度外展和外旋位。肩部活动时疼痛，腋窝区域有肿胀，触诊时有压痛。无感觉或运动功能障碍，外周脉搏相等且可触及。给予镇痛药后，采用屈曲 - 内收 - 外旋法进行肩关节复位。复位后，患者开始诉说腋窝疼痛。复查时，患者没有任何运动或感觉功能障碍，但右臂外周脉搏无法触及。因怀疑血管损伤而进行的右上肢计算机断层扫描血管造影显示右腋动脉破裂。
前肩关节脱位伴腋动脉损伤是一种罕见但严重的情况，可能导致肢体丧失和死亡。
