Neurovascular injuries to the shoulder complex.

ABSTRACT

The shoulder complex is particularly vulnerable to neurovascular injuries due to its intimate anatomical relationship with the brachial plexus and axillary vessels. Therapists, trainers, and physicians who cover athletic events witness the violence of injury to the neck and shoulder. Fortunately, permanent neurovascular deficits are rare, and many are subtle. However, tragically, some can be career-ending and even life-threatening. Neurovascular injuries may occur in association with musculoskeletal injury or as an isolated finding. Symptoms may present on an acute basis or in a chronic fashion. On the playing field or in the emergency room, focus is often placed on the obvious musculoskeletal injury, ie., dislocation or fracture. Medical personnel must always have a high index of suspicion of neurovascular injuries to the shoulder complex to avoid misdiagnosis. They must consider that failure to progress in rehabilitation for musculoskeletal injuries may be secondary to a previously unrecognized neurovascular lesion. The purpose of this review is to provide a basic reference for diagnosis and treatment of neurovascular injuries to the shoulder complex for therapists, trainers, and physicians. Also, we hope to raise the index of suspicion for neurovascular injuries during evaluation of patients with common shoulder injuries. The review is organized by location and association with specific musculoskeletal injuries.