Skip to main content
SpringerLink
Log in

Diagnosis and management of vascular injuries in the shoulder girdle of the overhead athlete

  • Published:
Current Sports Medicine Reports

Abstract

Vascular injuries represent a rare cause of shoulder pain and functional limitation among overhead athletes. Complaints of heaviness, fatigue, paresthesias, and effort-related pain should prompt the sports medicine clinician to consider vascular pathology as a possible cause of such symptoms. Position-dependent compression of the subclavian and axillary vessels within the thoracic outlet may result in functional limitation and a decline in overhead athletic performance, particularly when symptoms occur in the dominant upper limb. Treatment options include physical therapy and (in the case of thrombus) thrombolysis, but surgical decompression of the neurovascular bundle is generally advocated. This article reviews the diagnosis and management of effort thrombosis (also known as Paget-Schroetter syndrome), arterial thoracic outlet syndrome, and entrapment of the posterior circumflex humeral artery within the quadrilateral space. Familiarity with these conditions may help to minimize the risk of delayed diagnosis and associated morbidity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Treihaft MM: Neurologic injuries in baseball players. Semin Neurol 2000, 20:187–193.

    Article  PubMed  CAS  Google Scholar 

  2. Verhagen EA, Van der Beck AJ, Bouter LM, et al.: A one season prospective cohort study of volleyball injuries. Br J Sports Med 2004, 38:477–481.

    Article  PubMed  CAS  Google Scholar 

  3. Perkins RH, Davis D: Musculoskeletal injuries in tennis. Phys Med Rehabil Clin N Am 2006, 17:609–631.

    PubMed  Google Scholar 

  4. Johnson JN: Competitive swimming illness and injury: common conditions limiting participation. Curr Sports Med Rep 2003, 2:267–271.

    PubMed  Google Scholar 

  5. Ryu RK, Dunbar WH, Kuhm JE, et al.: Comprehensive evaluation and treatment of the shoulder in the throwing athlete. Arthroscopy 2002, 18(Suppl 2):70–89.

    PubMed  Google Scholar 

  6. Mosley JG: Arterial problems in athletes. Br J Surg 2004, 91:373–374.

    Google Scholar 

  7. Koffler KM, Kelly JD IV: Neurovascular trauma in athletes. Orthop Clin North Am 2002, 33:523–534.

    Article  PubMed  Google Scholar 

  8. Dumitru D: Electrodiagnostic Medicine, end 2. Philadelphia: Hanley & Belfus; 1995.

    Google Scholar 

  9. Poole GV, Thomae KR: Thoracic outlet syndrome reconsidered. Am Surg 1996, 62:287–291.

    PubMed  CAS  Google Scholar 

  10. Taylor A, Kerry R: Vascular issues in sport. Part 2: the upper limb. SportEX Med 2003, 15:9–13.

    Google Scholar 

  11. Arko FR, Harris EJ, Zarins CK, Olcott C: Vascular complications in high-performance athletes. J Vasc Surg 2001, 33:935–942.

    Article  PubMed  CAS  Google Scholar 

  12. Hurley WL, Comins SA, Green RM, Canizzaro J: Atraumatic subclavian vein thrombosis in a collegiate baseball player: a case report. J Athl Train 2006, 41:198–200.

    PubMed  Google Scholar 

  13. Smith RA Jr, Cummings JP: The axillary arch: anatomy and suggested clinical manifestations. J Orthop Sports Phys Ther 2006, 36:425–429.

    PubMed  Google Scholar 

  14. Chaudhry MA, Hajarnavis J: Paget-von Schrötter syndrome: primary subclavian-axillary vein thrombosis in sport activities. Clin J Sport Med 2003, 13:269–271.

    Article  PubMed  CAS  Google Scholar 

  15. Sabeti S, Schillinger M, Mlekusch W, et al.: Treatment of subclavian-axillary vein thrombosis: long-term outcome of anticoagulation versus systemic thrombolysis. Thromb Res 2002, 108:279–285.

    Article  PubMed  CAS  Google Scholar 

  16. O’Leary MR, Smith MS, Druy EM: Diagnostic and therapeutic approach to axillary-subclavian vein thrombosis. Ann Emerg Med 1987, 16:889–893.

    Article  PubMed  CAS  Google Scholar 

  17. Urschel HC, Kourlis H Jr: Thoracic outlet syndrome: a 50-year experience at Baylor University Medical Center. Proc (Bayl Univ Med Cent) 2007, 20:125–135.

    Google Scholar 

  18. Keisler BD, Armsey TD: Paget-Schroetter syndrome in an overhead athlete. Curr Sports Med Rep 2005, 4:217–219.

    PubMed  Google Scholar 

  19. Beygui RE, Olcott IV C, Dalman RL: Subclavian vein thrombosis: outcome analysis based on etiology and modality of treatment. Ann Vasc Surg 1997, 11:247–255.

    Article  PubMed  CAS  Google Scholar 

  20. Molina JE, Hunter DW, Dietz CA: Paget-Schroetter syndrome treated with thrombolytics and immediate surgery. J Vasc Surg 2007, 45:328–334.

    Article  PubMed  Google Scholar 

  21. DiFelice GS, Paletta GA Jr, Phillips BB, Wright RW: Effort thrombosis in the elite throwing athlete. Am J Sports Med 2002, 30:708–712.

    PubMed  Google Scholar 

  22. Duralde X: Surgical management of neurologic and vascular lesions in the athlete’s shoulder. Sports Med Arthrosc 2000, 8:289–304.

    Article  Google Scholar 

  23. Vanit C, Natalini L, Romeo A, et al.: Conservative treatment of thoracic outlet syndrome: a review of the literature. Eura Medicophys 2007, 43:55–70.

    Google Scholar 

  24. Durham JR, Yao JS, Pearce WH, et al.: Arterial injuries in the thoracic outlet syndrome. J Vasc Surg 1995, 21:57–70.

    Article  PubMed  CAS  Google Scholar 

  25. Casey RG, Richards S, O’Donohoe M: Exercise induced critical ischaemia of the upper limb secondary to a cervical rib. Br J Sports Med 2003, 37:455–456.

    Article  PubMed  CAS  Google Scholar 

  26. McFarland EG, Caicedo JC, Guitterez MI, et al.: The anatomic relationship of the brachial plexus and axillary artery to the glenoid: implications for anterior shoulder surgery. Am J Sports Med 2001, 29:729–733.

    PubMed  CAS  Google Scholar 

  27. Rohrer MJ, Cardullo PA, Pappas AM, et al.: Axillary artery compression and thrombosis in throwing athletes. J Vasc Surg 1990, 11:761–769.

    Article  PubMed  CAS  Google Scholar 

  28. Helm AT, Watson JS: Compression of the brachial plexus in a patient with false aneurysm of the axillary artery as a result of anterior shoulder dislocation. J Shoulder Elbow Surg 2002, 11:278–279.

    Article  PubMed  Google Scholar 

  29. Julia J, Lozano P, Gomez F, Corominas C: Traumatic pseudoaneurysm of the axillary artery following anterior dislocation of the shoulder. J Cardiovasc Surg 1998, 39:167–169.

    CAS  Google Scholar 

  30. Willis AA, Verma NN, Thornton SJ, et al.: Upper-extremity deep-vein thrombosis after anterior shoulder dislocation and closed reduction: a case report. J Bone Joint Surg Am 2005, 87:2086–2090.

    Article  PubMed  Google Scholar 

  31. Nuber GW, McCarthy WJ, Yao JS, et al.: Arterial abnormalities of the shoulder in athletes. Am J Sports Med 1990, 18:514–519.

    Article  PubMed  CAS  Google Scholar 

  32. Magee DJ: Orthopedic Physical Assessment, edn 3. Philadelphia: WB Saunders Co.; 1997.

    Google Scholar 

  33. Nichols AW: The thoracic outlet syndrome in athletes. J Am Board Fam Pract 1996, 9:346–355.

    PubMed  CAS  Google Scholar 

  34. Demondion X, Herbinet P, Van Sint JS, et al.: Imaging assessment of thoracic outlet syndrome. Radiographics 2006, 26:1735–1750.

    Article  PubMed  Google Scholar 

  35. Fujita K, Matsuda K, Sakai Y, et al.: Late thoracic outlet syndrome secondary to malunion of the fractured clavicle: a case report and review of the literature. J Trauma 2001, 50:332–335.

    Article  PubMed  CAS  Google Scholar 

  36. Mandal AKJ, Jordaan J, Missouris CG: Fractured clavicle and vascular complications. Emerg Med J 2004, 21:646–650.

    Article  Google Scholar 

  37. Schneider K, Kasparyan NG, Altchek DW, et al.: An aneurysm involving the axillary artery and its branch vessels in a major league baseball pitcher: a case report and review of the literature. Am J Sports Med 1999, 27:370–375.

    PubMed  CAS  Google Scholar 

  38. Dugas JR, Weiland AJ: Vascular pathology in the throwing athlete. Hand Clin 2000, 16:477–485.

    PubMed  CAS  Google Scholar 

  39. Reekers JA, den Hartog BM, Kuyper CF, et al.: Traumatic aneurysm of the posterior circumflex humeral artery: a volleyball player’s disease? J Vasc Interv Radiol 1993, 4:405–408.

    Article  PubMed  CAS  Google Scholar 

  40. Hoskins WT, Pollard HP, McDonald AJ: Quadrilateral space syndrome: a case study and review of the literature. Br J Sports Med 2005, 39:e9.

    Article  PubMed  CAS  Google Scholar 

  41. Vlychou M, Spanomichos G, Chatziiannou A, et al.: Embolization of a traumatic aneurysm of the posterior circumflex humeral artery in a volleyball player. Br J Sports Med 2001, 35:136–137.

    Article  PubMed  CAS  Google Scholar 

  42. Reeser JC: Infraspinatus syndrome. eMedicine J 2007. http://www.emedicine.com/sports/topic54.htm Accessed July 13, 2007.

  43. Kaminsky SB, Baker CL Jr: Neurovascular injuries in the athlete’s shoulder. Sports Med Arthrosc 2000, 8:170–181.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Marshfield Clinic Research Foundation, 1000 North Oak Avenue, Marshfield, WI, 54449, USA

    Jonathan C. Reeser

Authors
  1. Jonathan C. Reeser
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jonathan C. Reeser.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Reeser, J.C. Diagnosis and management of vascular injuries in the shoulder girdle of the overhead athlete. Curr Sports Med Rep 6, 322–327 (2007). https://doi.org/10.1007/s11932-007-0070-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11932-007-0070-3

Search

Navigation