A 28 year old woman fell off her horse and fractured thesurgical neck of the right humerus (A: red arrow). The CTAwas suggestive of a localised dissection (A: yellow arrow),but a catheter directed angiogram was normal (B). She wasmanaged conservatively with an arm sling and aspirin. Thefracture healed (C), but she subsequently developed rightarm claudication. Both Roo’s and Adson’s tests induced lossof her right radial pulse, suggestive of external compression.The artery was explored through an axillary approach.Therewas a fibrous sling (D: yellow arrow) causing entrapment ofthe artery, with loss of the arterial pulse distally (accessvideo via Supplementary Material). Upon release of thefibrous sling, the arterial calibre and distal pulsation wasrestored (E), with resolution of arm claudication. Delayedonset of arm claudication after a neck of humerus fractureshould raise the suspicion of axillary artery injury, includingexternal entrapment.
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