Deep Vein Thrombosis (DVT)

Written by admin on November 10, 2012 – 9:43 pm -

When hearing of a blood clot, one typically considers a person who recently had major surgery, for example, a knee replacement, or a traveler after a long plane ride. While these assumptions may be accurate, many are surprised to learn that athletes can develop blood clots as well. Serena Williams (Tennis) and Phil Dalhausser (beach volleyball) are two examples.

Blood clots are also referred to as a DVT or Deep Vein Thrombosis. They are most common in the legs, causing extreme calf pain, swelling and tightness, but also can occur in the upper extremity where they cause similar symptoms. DVT results from: diminished flow of blood through the veins, injury to the veins and hypercoagulability (“thickening” of the blood). Typically after surgery, patients are less able to move the lower extremities and joints due to pain and swelling. Since the flow of blood in the veins is dependent upon movement and contraction of muscles, this lack of mobility results in a decrease in blood circulation and increased viscosity (or thickness) of the blood. Both factors predispose to developing a clot. Upper extremity DVT is much less common, comprising only 10% of all cases of DVT. The typical cause of an upper extremity DVT in an athlete is repetitive micro-trauma of the subclavian or axillary veins (as is typical of a high level overhead athlete: tennis, volleyball, or baseball).

Signs and symptoms of an upper extremity DVT are similar to those seen in the lower extremity: pain, swelling and tightness of the affected arm/shoulder region.

DVT is a serious medical condition and can progress into an even more serious complication–pulmonary embolism. PE occurs when the blood clot or portion thereof, dislodges itself and travels into the lungs, causing shortness of breath, chest pain, dizziness and rapid pulse. PE can be fatal, and immediate medical attention must be sought if these symptoms occur.

Months before the London Olympics, Phil Dalhausser experienced significant swelling in his left arm. He was admitted to the hospital, diagnosed with DVT and treated with blood thinners (anti-coagulants and thrombolytic agents) to dissolve the clot. It was determined that the DVT was precipitated by scar tissue in his subclavian vein which resulted from being pinched between his first rib, collar bone and the surrounding muscles each time he struck the ball or reached for a block. Since his DVT, Dalhausser has successfully competed in the London Olympics representing the United States in men’s beach volleyball.

Serena Williams’ case, while much different was more typical. After sustaining a laceration in her foot, she first developed a hematoma in the wound. They are a local collection of blood but not related to DVT, nor can they ever become DVT or lead to PE. Hematomas result from blunt force trauma or within a healing wound. She subsequently developed a DVT in the same leg. Presumably this was the result of the immobilization required to allow the injury to heal. The pulmonary embolism occurred months after she cut her foot, and required immediate hospitalization. She recovered fully and won the 2012 US Open and gold medals in the London Olympics.

Resources:

Associated Press. (2011, March 02). Serena Williams hospitalized after suffering blood clot in lungs. Retrieved from http://www.foxnews.com/sports/2011/03/02/serena-williams-hospitalized-suffering-blood-clot-lungs/

Joffe, H. (2012). Upper-extremity deep vein thrombosis. Retrieved from http://circ.ahajournals.org/content/106/14/1874.full

Vein Specialists of the South. (2012). Olympic beach volleyball star develops blood clot in subclavian vein. Retrieved from http://varicoseveintreatmentga.com/wpi/deep-vein-thromobosis/olympic-beach-volleyball-star-develops-blood-clot-in-subclavian-vein/

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com or you can follow him on twitter: @drmarkgalland.

Kate Anderson, ATC/LAT is a post-graduate fellow at GOSM, Galland Orthopaedic and Sports Medicine. Follow her on twitter @kattethegreatt.


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