Warning: pulmonary embolism can occur after elective shoulder surgery—report of two cases and survey of the members of the American Shoulder and Elbow Surgeons

Pulmonary Embolism after Screw Fixation for a Greater Tubercle Fracture of Humerus

“…They postulated that a significant pooling of blood in the lower extremities because of lack of muscular pumping due to an upright, near seated position for an extended period of time, might contribute to the higher prevalence of DVT after shoulder arthroplasty. Rockwood et al 3) reported two cases of pulmonary embolism after elective shoulder arthroplasty. In one case, autopsy revealed a large clot in the femoral vein, but in the other, no evidence of DVT was found in upper or lower extremities.…”

“…The risk factors of pulmonary embolism are prior DVT, a history of pulmonary embolism, coagulation problems, chronic smoking, hypertension, diabetes, mobility limitation, obesity, venous stasis, phlebitis, a history of malignancy, and any other condition requiring prolonged bed rest. 3,5) Specific risk factors of shoulder arthroscopic surgery are operating in the lateral decubitus position with the affected limb in traction and a prolonged operative time. 5) Jameson et al 2) reported higher VTE rates for traumatic arthroplasty than for elective arthroplasty, but without major clinical significance (all lower than 1%).…”

“…Many agents have been used to DVT and pulmonary embolism, such as, aspirin, warfarin, low-molecular-weight dextran, heparin, or simply postoperative thigh-high intermittent pneumatic compressive devices. 3,4,8) The National Institute for Health and Clinical Excellence (NICE) in England recommended that high-risk patients undergoing upper limb surgery should be offered low-molecular weight heparin prophylaxis. 10) High-risk patients were defined as those aged over 60, those with significant comorbidities, those undergoing surgery with a combined anesthetic and surgical time of greater than 90 minutes, and obese patients.…”

“…It is rare after upper extremity surgery. The majority of reported cases of pulmonary embolism after upper extremity surgery have occurred in patients after shoulder arthroplasty, [1][2][3][4] shoulder arthroscopic surgery, 2,5-7) but their incidence rates are very low. Rarely, single cases of pulmonary embolism after open glenohumeral joint debridement, subacromial decompression of the shoulder, and surgical treatment of ulnar pseudoarthrosis have been reported.…”

Incidence of deep vein thrombosis following shoulder replacement surgery: a prospective study

“…Although this is a rare entity, major thrombotic complications following upper extremity DVTs, including symptomatic and fatal pulmonary embolism, have been documented. [1][2][3][4][5][6][7][8] Shoulder replacement surgery requires the joint to be dislocated to allow for bone cuts, canal reaming, implant positioning and glenoid evaluation and/or preparation. The affected limb is often positioned in extreme external rotation for a prolonged period.…”