ARTERIAL

COMPRESSION SYNDROMES AT THE SHOULDER PART 1: AN OVERVIEW

BY CLAIRE STAPLETON, MCSP

INTRODUCTION Arterial blood flow limitations are most commonly associated with atherosclerosis, the signs and symptoms of which present later in life with cardiovascular risk factors such as hypertension, hypercholesterolaemia, history of smoking, diabetes and low physical activity levels (1,2). Although rare, vascular injury can occur in the upper and lower limbs in young, fit and healthy individuals with no associated risk factors for cardiovascular disease (2,3). Symptoms such as pain, paraesthesia, anaesthesia and weakness can be vascular in origin, masquerading as neuromusculoskeletal conditions. A lack of awareness and clinical suspicion of vascular injuries in young, fit and healthy individuals leads to an absence of vascular examinations in clinical assessments and, consequently, misdiagnosis. It is vital that first-line clinicians consider the vascular system in their differential diagnosis, as failing to detect a significant arterial lesion can have devastating results, including

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Arterial compression syndromes affecting the subclavian artery, axillary artery and posterior humeral circumflex artery have been identified in young, fit and healthy athletes. Specific to the third portion of the axillary artery, the overhead-throwing motion in combination with excessive anterior translation of the humeral head has been implicated as a possible cause of vascular damage. This article briefly outlines the sites of potential arterial compression around the shoulder and summarises the effects of altered haemodynamics on the inner lining of the artery. Part 2 will be published in the next issue (April 09) and focusses on diagnostic arm manoevres used in physical examination, discusses some diagnostic dilemmas and highlights areas for research.

digital ulceration, gangrene, amputation, stroke and death (4–7). Upper-limb arterial injury is thought to result from repeated compression of the artery during movements of the shoulder girdle and arm. This article briefly outlines the sites of potential arterial compression around the shoulder and summarises the effects of altered haemodynamics on the inner lining of the artery (endothelium).

TO RESULT FROM REPEATED COMPRESSION OF THE ARTERY DURING MOVEMENTS OF THE SHOULDER GIRDLE AND ARM

sportEX medicine 2009;39(Jan):22-26

UPPER LIMB ARTERIAL INJURY IS THOUGHT