Brachial plexus compression: complication of delayed recognition of arterial injuries of the shoulder girdle.

In six cases of penetrating trauma to the subclavian or axillary arteries without primary coincident injury to the brachial plexus, the vascular injury was not initially recognized as there were no suggestive clinical signs. The first clinical sign of vascular injury in all cases was delayed onset of brachial plexus palsy due to compression by an expanding false aneurysm. Following vascular repair, neurological recovery occurred only in two of six cases. Since brachial plexus injuries are associated with a poor prognosis, and the functional impairment of the upper extremity is serious, an aggressive investigative approach to all penetrating shoulder girdle injuries is advocated. Arteriography should be considered, even when suggestive clinical signs of vascular injury are absent. Even relatively small false aneurysms should be repaired without delay before the onset of neurological symptoms.