Complications Nerve Block Arthroscopic Surgery

[CMCA1955]

I had arthroscopic surgery for frozen shoulder due to tears in lining and calcium buildup 4 weeks ago. They used a nerve block.  Had a lot of scar tissue that the Dr needed to break up before shaving so had a lot of bruising on the arm from the drs fingers, he said he was actually afraid he'd break my arm.  I had very little pain and I'm having a good recovery, going to pt and using a dynasplint to get my range of motion and stretch back.  My problem is I have a hemotoma where the nerve block was given.  They have done a ultrasound of my neck, shoulder and arm to make sure there is no blood clot, which was negative.  My orthopedic doctor at first said hemotomas develop sometimes and it should go away.  After my 30 day visit this week, he suggested I might consider seeing a nerve specialist to make sure it isn't an aneurism.  Some days its very swollen, some days you can bearly see. Is this a known side effect?  I've searched different sites and do not see any mention of 'hemotomas or aneurisms' associated with this surgery.

[Adult Neurology, M.D.]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I cannot tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Hematoma is a localized collection of extravasated blood, usually clotted, in an organ, space, or tissue. This can happen if the needle hits a small blood vessel and the blood comes out into the surrounding tissue. It is a common complication following a procedure which involves inserting needles into the tissues. Most of the time they are benign and self resolve.

I am not sure what exactly your doctor saw on the ultrasound which triggered him to mention evaluation of an “aneurysm”. An aneurysm is a localized, pathological, blood-filled dilatation of a blood vessel caused by a disease or weakening of the vessel's wall. So this is in the domain of a vascular surgeon not a nerve specialist.

One complication which can occur after an intervention which involves inserting needles into tissue is a psudoaneurysm. This may occur after arterial puncture.  A pseudoaneurysm, also termed a false aneurysm, is a leakage of arterial blood from an artery into the surrounding tissue with a persistent communication between the originating artery and the resultant adjacent cavity.
Some pseudoaneurysms resolve themselves, though others require treatment to prevent hemorrhage, an uncontrolled leak or other complications.
An ultrasound can be used to evaluate a puncture site if swelling, pain or extensive bruising suggests a pseudoaneurysm may have developed.
Surgery is sometimes required, but most pseudoaneurysms at arterial puncture sites can be treated with a brief, minimally-invasive procedure performed under local anesthesia. Ultrasound imaging guides placement of a needle into the pseudoaneurysm and then thrombin is injected. Thrombin is an enzyme that promotes rapid clot formation, immediately obliterating the pseudoaneurysm cavity when injected. There are some risks of an adverse reaction or clot formation in a major artery or vein (which might require urgent surgery), but the procedure is usually uncomplicated.


Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[CMCA1955]

Thank you that makes sense and I will consult with him.  THE swelling has subsided a lot, however, I can still feel it (almost feels like a gel pad under the skin).  Thank you again.

[Adult Neurology, M.D.]

I would advise going back to your doctor who did the nerve block and clarifying whether he meant a pseudoaneurysm or not and whether he wants you to see a nerve doctor or a vascular surgeon.

Thanks