Effort Thrombosis ICD-9
Effort Thrombosis Etiology / Epidemiology / Natural History
- Venous thrombosis of the upper extremity related to extreme stresses of the repetitive overhead-throwing motion.
- Generally only affects elite baseball players, especially pitchers
- Average age = 22
- Has been reported in baseball, softball, hockey, swimming, wrestling, martial arts, back packing, and billiards.
Effort Thrombosis Anatomy
- Generally occurs in the axillary or subclavian veins in close proximity to the intersection of the clavicle and first rib.
- Thrombosis occurs at the thoracic outlet, with compression of the vein at the level of the first rib.
Effort Thrombosis Clinical Evaluation
- Initial symptoms = arm “tiredness” or “heaviness” with gradual onset of swelling of the upper extremity.
- Additional symptoms: mild discoloration of the extremity, nonspecific paresthesia, palpable axillary cords.
- Venous engorgement of the arm, upper extremity swelling of several centimeters, discoloration, and palpable cords.
Effort Thrombosis Xray / Diagnositc Tests
Effort Thrombosis Classification / Treatment
- Transluminal catheter-directed urokinase thrombolysis followed by delayed first rib resection and systemic anticoagulantion for up to 3 months.
- Recommend hematology evaluation and serologic testing for Hypercoagulable states (anticardiolipin antibody)
Effort Thrombosis Associated Injuries / Differential Diagnosis
- Hypercoagulable states (anticardiolipin antibody)
- Pulmonary embolism
Effort Thrombosis Complications
Effort Thrombosis Follow-up Care
- Start graduated throwing program at 12 weeks postop with gradual progress to full activity/thromwingProgress to the premorbid level of throwing
- Return to competitive baseball by the following season.
Effort Thrombosis Review References
- DiFelice GS, AJSM 2002;30:708