Brachial plexus compression: complication of delayed recognition of arterial injuries of the shoulder girdle
S. Raju and D. V. Carner
In six cases of penetrating trauma to the subclavian or axillary arteries
without primary coincident injury to the brachial plexus, the vascular
injury was not initially recognized as there were no suggestive clinical
signs. The first clinical sign of vascular injury in all cases was delayed
onset of brachial plexus palsy due to compression by an expanding false
aneurysm. Following vascular repair, neurological recovery occurred only in
two of six cases. Since brachial plexus injuries are associated with a poor
prognosis, and the functional impairment of the upper extremity is serious,
an aggressive investigative approach to all penetrating shoulder girdle
injuries is advocated. Arteriography should be considered, even when
suggestive clinical signs of vascular injury are absent. Even relatively
small false aneurysms should be repaired without delay before the onset of
neurological symptoms.
