Axillary artery aneurysm with distal embolization in a major league baseball pitcher

Aneurysms of the axillary artery and occlusions of the humeral circumflex arteries in elite baseball pitchers are not rarities. (1,6,7,11,14,17,18,20) Although this entity is well described in the vascular surgery literature, there are few reports in the orthopaedic literature. 16,19,21 This is important because most team physicians are orthopaedic surgeons, and the team physician will often have the first chance to make a diagnosis and initiate early treatment. Early detection and treatment of axillary artery aneurysms may prevent catastrophic injury and may allow the professional baseball player to continue pitching at an elite level and prolong his career. (6,7) The presenting symptoms of axillary artery aneurysms rarely originate from the shoulder region. Instead, the presenting symptoms are often attributable to ischemia of the distal extremity caused by emboli that originated from the more proximal aneurysm. Hand and finger numbness with the sensation of "coldness" in the fingertips while gripping and throwing a baseball is most often the presenting symptom. Patients may also report decreased endurance in their arm during pitching. The signs and symptoms may be subtle, and the physician must consider this diagnosis in any baseball player complaining of these symptoms. We report on a professional baseball pitcher who was diagnosed with an axillary artery aneurysm and occlusion of the humeral circumflex artery with distal embolization that failed non-operative treatment and required surgical resection of the aneurysm.