Spike the PCHA! Overuse injury of the Posterior Circumflex Humeral Artery in elite volleyball

In 1993, professor Reekers of the Academic Medical Center (AMC) Radiology department was the first to describe a traumatic aneurysm of the posterior circumflex humeral artery (PCHA) in a volleyball player, suggesting a causal relationship. Fifteen years later, between 2008 and 2010, several elite male volleyball players presented themselves in the AMC in Amsterdam with ischemic digits in the spiking hand due to arterial emboli originating from an aneurysmal and thrombosed PCHA in the dominant shoulder. At that time, just five case reports had been published worldwide on volleyball players with this injury. Knowledge about this sports-related overuse injury needs to be extended on an international scale considering the potential amputation of a finger as the devastating end result in a population of young, healthy and fit elite volleyball players. In this thesis, the first steps of elucidating the unexplored entity of Shoulder PCHA pathology and digital Ischemia in Known Elite volleyball players (SPIKE) are made in order to provide an effective contribution to knowledge about this vascular overuse injury. In volleyball, spiking is the act of scoring a point by slamming the ball over the net into the opposing court effectively. Hence the title SPIKE the PCHA. The first part of the thesis (PART I) covered our research on clinical characteristics like symptomatology and associated risk factors. PART II focused on research on optimal imaging strategies for detection and prevention. Combining new findings with conclusions from Part I and II generates suggestions for clinical management, discussed in PART III