Effort Thrombosis 453.82

synonyms:

Effort Thrombosis ICD-9

• 453.82 Acute venous embolism and thrombosis of the deep veins of upper extremity

Effort Thrombosis Etiology / Epidemiology / Natural History

• Venous thrombosis of the upper extremity related to extreme stresses of the repetitive overhead-throwing motion.
• Uncommon
• 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

• Contrast venography:

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

• Venous stenosis

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