Thromboembolic events are one of the most serious and potentially fatal complications that can occur after an orthopedic surgery, especially pulmonary thromboembolism (PE). However, the incidence of such events are rare, specifically after upper limb surgery. We presented two cases of PE after shoulder arthroscopy, in healthy patients, with no previous history of thromboembolic events. The PE presented in the first two postoperative weeks and both patients were anticoagulated and had full recovery. The occurrence of the thromboembolic events did not affect the clinical outcome of the shoulder. In this paper we try to identify possible risk factors and discuss the need of thromboprophylaxis, relating them to current literature. The first case of deep venous thromboembolism (DVT) after shoulder arthroscopy was reported by Burkhart in 1990. Since then, few cases have been reported in the medical literature. Some risk factors have been discussed, such as: smoking, chronic obstructive pulmonary disease (COPD), high anesthetic risk (American Society of Anesthesiologists - ASA grade III or higher), age older than 60 years, obesity, and operative time longer than 90 minutes. There is no consensus about the impact of surgical positioning on the incidence of DVT and PE. Regarding prophylaxis, the advantages and impact of chemoprophylaxis remains controversial but should be considered in high-risk patients. On the other hand, mechanical prophylaxis should always be performed, from early ambulation to compression stockings and sequential compression devices, if available. There is no level I evidence on occurrence of VTE after shoulder arthroscopy.

Keywords: Shoulder; Arthroscopy; Pulmonary thromboembolism; Rotator cuff repair; Case report