{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T16:32:55Z","timestamp":1777134775749,"version":"3.51.4"},"reference-count":17,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"8","license":[{"start":{"date-parts":[[2005,8,1]],"date-time":"2005-08-01T00:00:00Z","timestamp":1122854400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery. British volume"],"published-print":{"date-parts":[[2005,8]]},"abstract":"<jats:p> We describe 20 patients, aged between 43 and 88 years, with delayed nerve palsy or deepening of an initial palsy caused by arterial injury from low-energy injuries to the shoulder. The onset of palsy ranged from immediately after the injury to four months later. There was progression in all the patients with an initial partial nerve palsy. Pain was severe in 18 patients, in 16 of whom it presented as neurostenalgia and in two as causalgia. Dislocation of the shoulder or fracture of the proximal humerus occurred in 16 patients. There was soft-tissue crushing in two and prolonged unconsciousness from alcoholic intoxication in another two. <\/jats:p><jats:p> Decompression of the plexus and repair of the arterial injury brought swift relief from pain in all the patients. Nerve recovery was generally good, but less so in neglected cases. The interval from injury to the repair of the vessels ranged from immediately afterwards to 120 days. <\/jats:p><jats:p> Delayed onset of nerve palsy or deepening of a nerve lesion is caused by bleeding and\/or impending critical ischaemia and is an overwhelming indication for urgent surgery. There is almost always severe neuropathic pain. <\/jats:p>","DOI":"10.1302\/0301-620x.87b8.15976","type":"journal-article","created":{"date-parts":[[2005,7,27]],"date-time":"2005-07-27T22:26:04Z","timestamp":1122503164000},"page":"1102-1106","source":"Crossref","is-referenced-by-count":43,"title":["Low-energy arterial injury at the shoulder with progressive or delayed nerve palsy"],"prefix":"10.1302","volume":"87-B","author":[{"given":"M.","family":"Stenning","sequence":"first","affiliation":[{"name":"Orthopaedic Department, Walsgrave Hospital, Clifford Bridge Road, Coventry CV2 2DX, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Drew","sequence":"additional","affiliation":[{"name":"Orthopaedic Department, Walsgrave Hospital, Clifford Bridge Road, Coventry CV2 2DX, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Birch","sequence":"additional","affiliation":[{"name":"PNI Unit Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, Middlesex, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"42","reference":[{"key":"R1","unstructured":"Birch R, Bonney G. Compound nerve injuries: the vascular lesion. In: Birch R, Bonney G, Wynn Parry CB, eds. Surgical disorders of the peripheral nerves. First ed. London: Churchill Livingstone, 1998:125\u201334."},{"key":"R2","doi-asserted-by":"crossref","unstructured":"Gates JD, Knox JB. Axillary artery injuries secondary to anterior dislocation of the shoulder. J Trauma 1995;39:581\u20133.","DOI":"10.1097\/00005373-199509000-00030"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-1383(02)00091-8"},{"key":"R4","unstructured":"Lundborg G. Vascular systems. In: Nerve injury and repair. Edinburgh: Churchill Livingstone, 1988:32\u201363."},{"key":"R5","unstructured":"McManis PG, Low PA, Lagerlund TD. Microenvironment of nerve: blood flow and ischaemia. In: Dyck PJ, Thomas PK, Griffin JW, Low PA, Poduslo JF, eds. Peripheral neuropathy. Third ed. Philadelphia: W.B. Saunders Co. 1993:433\u201340."},{"key":"R6","unstructured":"Seddon HJ. Neurovascular injuries. In: Surgical disorders of peripheral nerves. 2nd Edition. Edinburgh, etc: Churchill Livingstone, 1975:89\u2013111."},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.286.6380.1785"},{"key":"R8","unstructured":"Lewis T, Pickering GW, Rothschild P. Centripetal paralysis arising out of arrested bloodflow to the limb: including notes on a form of tingling. Heart 1931;16:1\u201332."},{"key":"R9","unstructured":"Barros D\u2019Sa. Arterial injuries. In: Eastcott HHG, ed. Arterial surgery. Third ed. London: Churchill Livingstone, 1992:355\u2013413."},{"key":"R10","unstructured":"Fiolle J, Delmas J. In: Cumston CG (trans ed). The surgical exposure of the deep seated blood vessels. London: Heinemann, 1921:61\u20137."},{"key":"R11","unstructured":"Birch R, Bonney G. Operating on peripheral nerves. In: Birch R, Bonney G, Wynn Parry CB, eds. Surgical disorders of the peripheral nerves. First ed. London: Churchill Livingstone, 1998:87\u2013106."},{"key":"R12","unstructured":"Birch R, Bonney G. Results. In: Birch R, Bonney G, Wynn Parry C, eds. Surgical disorders of the peripheral nerves. First ed. London: Churchill Livingstone, 1998:235\u201342."},{"key":"R13","unstructured":"Seddon HJ. Results of repair of nerves. In: Surgical disorders of peripheral nerves. Second ed. Edinburgh: Churchill Livingstone, 1975:303\u201314."},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.83B4.0830517"},{"key":"R15","unstructured":"Barnes R. Causalgia: a review of 48 cases. In: Seddon HJ, ed. Peripheral nerve injuries by the Nerve Injuries Committee of the Medical Research Council. Medical Research Council Special Report series 282. Ed. London: Her Majesty\u2019s Stationery Office, 1954:156\u201385."},{"key":"R16","unstructured":"Eastcott HHG, Blaisdell FW, Silver D. Acute ischaemia. In: Eastcott HHG, ed. Arterial surgery. Third ed. Edinburgh: Churchill Livingstone, 1992:31\u201354."},{"key":"R17","unstructured":"Barros d\u2019Sa. Arterial injuries. In: Eastcott HHG, ed. Arterial surgery. Third ed. Edinburgh: Churchill Livingstone, 1992:355\u2013413, 363\u20134."}],"container-title":["The Journal of Bone and Joint Surgery. 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