Year Book: Upper Extremity *Arterial* Injury in Athletes
McCarthy-WJ. Yao-JST. Schafer-MF. Nuber-G. Flinn-WR. 1990 Year Book of Hand Surgery. Article 7-2. Original Article: J Vasc Surg. 1989 Feb. 9. pp 317-327. There are 2 common sources of use-related vascular problems in the upper extremity. One source is repetitive blunt *trauma* (impact, pressure, vibration) to the hand, usually the palm. The other is the rigorous repetitive shoulder motion required in certain athletic activities, which may lead to thoracic outlet compression and upper extremity ischemia in conditioned athletes. During a 5-year period, 21 men and 2 women aged 18-47 years were evaluated for arm and hand complaints. Nine of 12 men with hand complaints were professional baseball catchers. Seven of 11 athletes with symptoms suggestive of compression of a subclavian or axillary artery were baseball pitchers. Hand complaints included cold hypersensitivity, numbness, coolness, and blanching of fingers. Chronic arm complaints included severe throwing arm fatigue and heaviness, severe finger ischemia from emboli, and hand coldness. Noninvasive testing included Doppler ultrasound, duplex scanning, and cold immersion. Arteriography in the 11 athletes with arm complaints confirmed 2 subclavian aneurysms and compression of 1 or more arteries, including subclavian, axillary, and posterior humeral circumflex arteries. Arteriography also confirmed an ulnar artery thrombosis in a first baseman and occlusion of the palmar arch in a frisbee player. Both patients required hospitalization, during which they were treated first with vasodilator infusions, and then with heparin and dextran infusions for 2-4 days. Both returned to competitive athletics. The other patients with hand ischemia were managed nonoperatively. The 2 patients with subclavian artery aneurysms were treated with saphenous vein bypass and cervical rib resection. Eight athletes with muscular compression of an artery underwent standard surgical decompression of the thoracic outlet with anterior scalene or pectoralis minor muscle resection. One pitcher with distal embolization and circumflex humeral branch thrombus did not have an operation. All athletes were able to continue their professional or recreational activities. Repetitious blunt hand *trauma* or violent shoulder motion may compromise the upper extremity *arterial* system in athletes. Early noninvasive *arterial* examination can prevent the sequelae of *arterial* thrombosis.
Original Text by Clifford R. Wheeless, III, MD.
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