Deep vein thromboembolism after arthroscopy of the shoulder: two case reports and a review of the literature

Abstract

BackgroundDeep vein thrombosis (DVT) has an incidence of 1 case per 1000 inhabitants in the general population and it is very rare after arthroscopy of the shoulder. Therefore, the current guidelines do not advise the administration of DVT prophylaxis in shoulder arthroscopy procedures.Cases presentationWe describe two cases of thrombosis of the arm after shoulder arthroscopy on a total of 10.452 shoulder arthroscopies performed during a period of ten years. One of two patients was further complicated by a bilateral pulmonary microembolism. In these two clinical cases the complication developed despite the absence of risk factors such as a concomitant neoplasm, thrombophilia, smoking habit, or a long duration of the procedure.ConclusionsThe DVT after shoulder arthroscopy procedure remain a very rare complication. However, in view of the growing number of patients undergoing this procedure, this figure is expected to rise. The clinician surgeon should take in mind this possible complication that normally appears in the first 3 weeks after surgery, so to perform anti-coagulant treatment. Further clinical studies are therefore warranted to assess the true risk of VTE. In fact, the presence of "minor" predisposing factors that are not routinely studied, as well as the postoperative immobilization period, are potential risk factors that, associated with the invasiveness of the arthroscopy procedure, could trigger a thromboembolism.

Basic Shoulder Arthroscopy: Lateral Decubitus Patient Positioning

“…Ellman 14 reported a neuropraxia rate of 7.5% that was attributed to poor padding during the setup for the lateral decubitus position; thus, the second key step is assuring that bony prominences are padded to prevent neuropraxias and excessive skin pressure. Finally, multiple authors identified a greater rate of thromboembolic events with patients in the lateral position compared with the beach chair position [15][16][17] ; thus, the application of sequential compression devices at the beginning of the patient positioning process and ensuring their use during the surgical procedure is undertaken to help reduce the risk of deep vein thrombosis. Several advantages of the lateral decubitus position have been described in the literature.…”

Venous Thromboembolism in Patients Undergoing Shoulder Arthroscopy

“…4 To the best of our knowledge, the incidence and risk factors for VTE in shoulder arthroscopy haven't been investigated in prospective epidemiological studies. Some independent, retrospective, observational studies and case series have reported a quite low VTE rate in shoulder arthroscopy [5][6][7][8][9][10][11][12] ; moreover, a few information is available on the safety and efficacy of thromboprophylaxis in this setting. Thus, current guidelines on the prevention of VTE in patients undergoing orthopedic surgery do not have a specific recommendation for those undergoing shoulder arthroscopy.…”

L’artroscopia operativa: profilassi antitrombotica, anestesia neurassiale e blocchi continui periferici

“…La letteratura al riguardo consiste essenzialmente nella descrizione di casi singoli, con poche serie di pazienti. L'analisi di cinque studi che hanno valutato prevalenza o incidenza di tromboembolismo sintomatico dopo artroscopia della spalla, per un totale di oltre 23.000 artroscopie [12][13][14][15][16], suggerisce una frequenza intorno all'uno per mille di eventi tromboembolici. Per alcuni Autori, il decubito laterale del paziente aumenta il rischio di complicanze tromboemboliche a causa della trazione causante una ridotta perfusione dell'arto superiore interessato [14,[17][18][19], ma fenomeni trombotici sono stati descritti anche col decubito "sedia a sdraio" [13,20,21].…”