Deep Vein Thrombosis
- Description/Cause
- Upper extremity deep vein thrombosis (UEDVT) is a condition that poses a risk for serious and sometimes deadly events, such as pulmonary embolisms
- Prevalence/Risk Factors
- Prevalence:
- 11% of all DVTs are known to occur in the veins of the arm and forearm
- 20% of primary cases are believed to occur sporadically and are considered idiopathic
- remainder occur in setting of Paget-Schroetter syndrome or venous thoracic outlet syndrome
- "effort-induced" or Primary UEDVT is also known as Paget-Schroetter Syndrome
- occurs in young and healthy individuals engaging in such strenuous activities as weight-lifting, rowing or wrestling
- more evident when accompanied by pre-existing anatomic abnormalities
- Most frequently occur secondary to a medical comorbidity, including shoulder arthroscopy
- Most common cause of secondary UEDVT is implementation of central venous catheters
- Account for 72% of UEDVT
- 0.52% rate of DVT in shoulder replacements
- 0.64% in procedures for fractures of the proximal humerus
- 0.26% in replacement of the elbow
- <0.01%-0.38% risk of DVT following shoulder arthroscopy; however, may be underestimated due to the fact that many go undiagnosed
- Risk Factors:
- Upper extremity arthroscopic surgery
- Humerus fracture
- History of DVTs or hyper coagulation
- Central venous catheter
- Excessive effort
- Intravenous drug abuse
- Mediastinal tumor
- Lung Cancer
- Trauma
- Hormone or steroid usage
- Obesity
- Thoracic Outlet Syndrome
- Hypertension
- Radiation
- Signs and Symptoms
- Symptoms
- Asymptomatic
- Swelling and Edema
- Hallmark sign of UEDVT
- Seen in approximately 80% of patients
- Medial Elbow Pain
- Seen in approximately 30-50% of patients
- Erythema/Ecchymosis
- Seen in approximately 15% of patients
- Paresthesias
- Pruritus
- Signs
- Low-grade fever
- Oedema
- Objective and Special Tests
- Palpation
- Tenderness
- Swelling
- Palpable cord
- Duplex Ultrasonography
- Contrast Venography
- Treatments and Interventions
- Anti-Coagulation Therapy
- Blood thinners (Aspirin, Warfarin, etc.)
- Enoxparin
- Conservative Management
- Bed rest
- Local heat
- Limb elevation
- Compression arm sleeve
- Anticoagulation
- Thrombolytics
- Surgical Management
- Adhesion lysis
- Resection of first rib, clavicle or scalene muscles
- Subclavian vein patching or bypass procedure
- Subclavian balloon angioplasty with or without stent
- Superior vena cava filters
References
- Manaqibwala M, Ghobrial I, Curtis A. Upper Extremity Thrombosis Presenting as Medial Elbow Pain after Shoulder Arthroscopy. Case Reports In Orthopedics [serial online]. January 2014;:1. Available from: Publisher Provided Full Text Searching File, Ipswich, MA. Accessed July 1, 2015.
- Sawyer G, Hayda R. Upper-extremity deep venous thrombosis following humeral shaft fracture. Orthopedics [serial online]. February 2011;34(2):141. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed July 1, 2015.
- Madhusudhan T, Sinha A, Widdowson D. Deep vein thrombosis in shoulder arthroplasty - a prospective study. BMC Musculoskeletal Disorders [serial online]. June 2013;14(1):1-4. Available from: Academic Search Complete, Ipswich, MA. Accessed July 1, 2015.
Acknowledgements:
David Funk, Student Physical Therapist at A.T. Still University
Ethan Hunke, Student Physical Therapist at A.T. Still University
Morgan Johnson, Student Physical Therapist at A.T. Still University
Ed Nheiu, Student Physical Therapist at A.T. Still University
Lindsay Walczak, Student Physical Therapist at A.T. Still University
Last edited: July 13, 2015