Clinical Pearls: Left Arm Swelling

Upper extremity deep venous thrombosis after shoulder arthroscopy: A case report

“…2 Upper extremity DVT can be classified into primary and secondary types. 17 Primary upper extremity DVT, also known as Paget-Schroetter syndrome or idiopathic upper extremity DVT, is a rare entity (2/100,000 persons per year). It typically occurs in young, healthy male persons after strenuous occupational or sporting activities.…”

“…Other secondary causes of hypercoagulable states include lupus, pregnancy, nephrotic syndrome, surgery and immobilization, and protein S, protein C, and antithrombin III deficiency. 17 Thromboembolic complications after arthroscopic shoulder surgery are rare when compared with knee arthroscopy. Schippinger et al 13 prospectively evaluated 101 consecutive knee arthroscopy patients with ultrasound, phlebography, and lung scanning.…”

“…Therapeutic modalities include anticoagulation, thrombolysis, and invasive techniques, such as local catheter-guided thrombolysis, percutaneous mechanical thrombectomy, and open surgical thrombectomy. 1,11,17 The goal of treatment is to limit patient discomfort and symptoms, as well as to prevent post-thrombotic syndrome and pulmonary embolism. The frequency of post-thrombotic syndrome ranges from 7% to 46%, with a weighted mean of 15%.…”

“…The differential diagnosis for pain and swelling in an upper arm includes superficial phlebitis, cellulitis, contusions, muscle tears, intramuscular hemorrhage, gas gangrene, lymphedema, occult fracture, lymphangitis, allergy, and DVT. 17 An upper extremity Doppler ultrasound was performed and confirmed a DVT in the patient's brachial, medial antecubital, and distal cephalic veins. He was evaluated by an internist on the same day and started taking Lovenox (Aventis Pharmaceuticals, Bridgewater, New Jersey) until he was able to start taking warfarin (ie, when his international normalized ratio was between 2.0 and 3.0).…”

Upper Extremity Thrombosis Presenting as Medial Elbow Pain after Shoulder Arthroscopy

“…All of the patients in this report presented with medial elbow pain with variable degrees of localized swelling. The differential diagnosis for significant upper extremity swelling includes superficial phlebitis, cellulitis, contusion, muscle tear, intramuscular hemorrhage, gas gangrene, lymphedema, occult fracture, lymphangitis, allergy, and certainly DVT [8, 19]. Swelling is the most common presenting feature of DVT, whereas medial elbow pain is not a typical finding (Figure 1) [5].…”