Unique Treatment Regimen for Effort Thrombosis in the Nondominant Extremity of an Overhead Athlete: A Case Report

Abstract

Objective: To advise athletic trainers on the potential for effort thrombosis to occur in nonthrowing athletes and to underscore the importance of early recognition and treatment. Background: An 18-year-old offensive lineman presented with a 1-day history of diffuse shoulder pain with no specific history of injury; swelling and erythema involved the entire left upper extremity. He was immediately referred to the team physician, who suspected deep vein thrombosis and sent the athlete to an imaging center. Duplex ultrasound was obtained on the day of presentation, and he was admitted to the hospital that evening. Differential Diagnosis: Deep vein thrombosis, thoracic outlet syndrome, shoulder tendinitis. Treatment: Anticoagulation with heparin was administered at the hospital, and he was sent home the next day on subcutaneous enoxaparin sodium, followed by a 5-mg daily dose of oral warfarin sodium. Oral anticoagulants were continued for a total of 4 weeks. The athlete began upper body lifting and was released 5 weeks postinjury to gradually return to football without restrictions. Uniqueness: Effort thrombosis is typically seen in the dominant arm of athletes, and the current treatment protocol calls for thrombolysis or surgical intervention. This athlete, whose position required repeated elevation of his arms in forward flexion, sustained the injury in his nondominant arm, was treated with anticoagulation only, and had a full return to football. At 18-month follow-up, he had no recurrence of symptoms. Conclusions: Early recognition and treatment of athletes with effort thrombosis is paramount to a successful clinical outcome and prompt return to play.

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

“…The remaining cases are attributable to cancer, the use of oral contraceptives, pregnancy, congenital thrombophilia, acquired coagulation defects, diabetes mellitus, obesity, smoking habit or intense sports activity [10,8,13]. Blon et al underline the importance of assessing the risk factors considered up to now only for the legs, namely surgery, trauma, immobilization.…”

Upper extremity deep vein thrombosis presenting to a chiropractic clinic: a description of 2 cases

“…4 It occurs predominantly in young patients and affects males more commonly than females. 9,10 It commonly follows repetitive arm motion or extreme exertion; therefore, the dominant limb is most commonly affected.…”

“…[1][2][3] Upper extremity deep vein thromboses are categorized as primary or secondary, and relate to UEDVT affecting the subclavian (18%-69%), axillary (5%-42%), or brachial (4%-13%) veins. [1][2][3][4][5][6][7] Approximately one-third of UEDVT s are primary in nature, which include idiopathic thromboses or effort-induced thromboses. 2,4 Effort or activity-related UEDVT are sometimes referred to as Paget-Schroetter syndrome (PSS).…”

“…[1][2][3][4][5][6][7] Approximately one-third of UEDVT s are primary in nature, which include idiopathic thromboses or effort-induced thromboses. 2,4 Effort or activity-related UEDVT are sometimes referred to as Paget-Schroetter syndrome (PSS). 4 The term PSS was first used by Hughes in 1949 in his review of 320 cases of subclavian vein thrombosis.…”

“…2,4 Effort or activity-related UEDVT are sometimes referred to as Paget-Schroetter syndrome (PSS). 4 The term PSS was first used by Hughes in 1949 in his review of 320 cases of subclavian vein thrombosis. 5,8 Sir James Paget identified the first case in 1875 in a patient with acute arm pain and swelling.…”