Isolated axillary artery injury due to blunt trauma in ice hockey

We report the first case of a purely isolated axillary artery dissection because of focal blunt trauma to the axilla. A 42-year-old man presented to our outpatient orthopedic clinic 7 days after a fall during a hockey game whereby another player's skate blade struck the patient directly in the axilla without disrupting the skin. The patient denied having any symptoms of shoulder dislocation but experienced some pain and numbness, which subsided rapidly. Then he developed a cool hand with exertional claudication. Physical examination revealed absent radial and brachial pulses. Computed tomographic angiography demonstrated dissection of the distal axillary artery extending to the middle two-thirds of the brachial artery. Following urgent consultation with vascular surgery, the patient was treated operatively with reverse saphenous interpositional grafting and embolectomy. This case illustrates the need to have a heightened index of suspicion to all injuries to the axilla and the importance of performing careful soft tissue and neurovascular examinations in hockey players presenting with shoulder complaints, even when bony injury is not present.