Pseudoaneurysm: A Potential Risk Of Shoulder Arthroscopy

Health & Medical Blog

Pseudoaneurysm, although rare, can be a complication following an injury to your shoulder. In some cases, it occurs following shoulder arthroscopy -- a procedure your orthopedic surgeon may use to look inside your shoulder joint in order to diagnose and repair a shoulder problem.

Sometimes referred to as a false aneurysm, a pseudoaneurysm can form after a penetrating or blunt injury to the area beneath the joint where your arm connects to your shoulder (commonly known as the armpit). Delayed diagnosis and treatment of pseudoaneurysm can lead to permanent damage to the nerves that send signals from the spine to the shoulder; therefore, you need to report any unexpected or unusual postoperative symptoms to your doctor.

Symptoms and Diagnosis

When trauma or puncture wounds from arthroscopy to the shoulder area occur, blood can leak and pool outside the artery supplying blood to the area. The axillary artery is the blood vessel that carries oxygen-rich blood away from the heart to the upper limbs, armpit regions, and chest area between the neck and abdomen. Paralysis of the affected arm can occur if the untreated pseudoaneurysm increases in size and presses on the brachial plexus -- the network of nerves that control feeling and movement in your shoulders, arms, and hands.

Your doctor may suspect injury to the axillary artery if:

  • Trauma or a puncture wound occurs close to a major artery

  • There are signs of circulation problems (tingling and numbness) in your arm

  • You experience persistent or severe pain in your shoulder and arm

  • Bruising, swelling, or a large hematoma develop

  • You suffer the onset of progressive nerve-related problems which may include muscle weakness, a burning sensation, numbness, and tingling

Blood tests your doctor orders that show a significant drop in hemoglobin or hematocrit can also be a sign of a pseudoaneurysm. Low hemoglobin may indicate bleeding inside your body caused by damage to an artery or blood vessels. A low hematocrit (the volume of red blood cells in the blood) is another sign of bleeding.

If other symptoms related to axillary artery injury appear and lab studies come back abnormal following your arthroscopic procedure, your doctor may order an ultrasound study to evaluate the puncture site. In some cases, doctors rely on angiography of the upper extremity to examine the inside of blood vessels and detect the problem.

Treatment Options

Although treating a bleeding pseudoaneurysm may require surgery, in some cases, a minimally invasive procedure is all that is needed. Instead of an open surgical procedure, treatment may involve endovascular embolization to seal off the damaged blood vessel or inserting a stent -- a wire mesh tube -- to divert the flow of arterial blood. Another technique your surgeon may decide to use is injecting thrombin directly into the pseudoaneurysm. However, depending on the severity of the complication, your case may require open surgery to repair the subclavian artery damage. Like other open surgical procedures, it carries a higher risk than other, less-invasive procedures. Contact a shoulder surgeon like one from Interior Alaska Orthopedic & Sports Medicine for more information.


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