Upper-Limb Ischemia Due to Distal Embolization from a Dissecting Axillary Artery Pseudoaneurysm in an Elite Overhead Athlete: A Case Report

In overhead-throwing athletes, repetitive shoulder motion may cause intimal injury and pseudoaneurysm formation, most commonly involving the posterior circumflex humeral artery. An elite cricket fast bowler in his 20s presented with 6 months of left shoulder and hand discomfort, followed by rest pain and numbness of the fourth and fifth fingers. Duplex ultrasonography showed thrombosis of an axillary artery pseudoaneurysm with distal radial and ulnar artery embolization, and magnetic resonance imaging demonstrated a 1.5-cm pseudoaneurysm at the origin of the subscapular artery. Surgical exploration revealed a spiral intimal dissection with organized thrombus. The pseudoaneurysm was excised, the intima was secured with tacking sutures, the axillary artery was repaired with a great saphenous vein patch, and thromboembolectomy was performed. The patient returned to work at 6 months without residual deficits. Delayed diagnosis may compromise limb salvage and functional recovery. Early recognition of vascular pathology is essential in overhead athletes.