General medical conditions occurring in athletes is one of my high interest areas, and I came across this case report recently that really caught my eye. AT textbooks tend to lean their attention towards the lower extremity, which in turn can lull us into a state of thought which restricts DVT's from occurring in the upper extremity, when in fact, they can and do. This particular case involved the non-dominant arm of an offensive lineman, which might throw off your evaluation for two reasons:
1. It's the non-dominant arm
2. Presentation occurred in a "traditionally" non-overhand athlete (as compared to say a baseball or volleyball player).
Additionally, he had no recollection of specific trauma.
Treatments can range from oral anti-coagulant therapy, to thrombolysis or even surgical intervention, (or combination of case dependent of course. In this athlete's case, he was treated solely with oral anti-coagulant therapy for a shorter period of time than most (4 weeks).
So how do thromboses occur? For that, we turn to Virchow's Triad. What is that? Well, this link shows a great chart which helps explain the causes therein; Essentially, Virchow's Triad lists blood coagulation issues, vessel wall abnormalities, and blood flow issues as causes. The chart displays specific examples (trauma, varicose veins, and malignancy, to name a few) as well.
1. It's the non-dominant arm
2. Presentation occurred in a "traditionally" non-overhand athlete (as compared to say a baseball or volleyball player).
Additionally, he had no recollection of specific trauma.
Treatments can range from oral anti-coagulant therapy, to thrombolysis or even surgical intervention, (or combination of case dependent of course. In this athlete's case, he was treated solely with oral anti-coagulant therapy for a shorter period of time than most (4 weeks).
So how do thromboses occur? For that, we turn to Virchow's Triad. What is that? Well, this link shows a great chart which helps explain the causes therein; Essentially, Virchow's Triad lists blood coagulation issues, vessel wall abnormalities, and blood flow issues as causes. The chart displays specific examples (trauma, varicose veins, and malignancy, to name a few) as well.
I have started to type multiple questions in here then realized I should probably just look them up. I found many answers on this website: http://circ.ahajournals.org/cgi/content/full/93/12/2212
ReplyDeleteI didn't find how we as athletic trainers should immediately manage a DVT. Yes it needs to be referred to a physician if we suspect it, but if the physician isn't available that day do we send the athlete to the hospital? Also, do we sling and swathe them to relieve stress on the shoulder in this case? Do we apply ice to the painful area? Would compression increase the risk of the clot breaking free?
Great question(s). First of all, if you suspect a DVT at all, refer immediately to the hospital/ER. Time is of the essence. From what I've read, transfer in position of comfort. The athlete may be self splinting, so sling and swathe may be appropriate for some. Ice and compression likely won't come into play if you suspect this issue. Refer, and see what comes back.
ReplyDeleteDeep vein thrombosis refers to a blood clot embedded in one of the major deep veins of the legs, thighs, or pelvis.
ReplyDeleteveins