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Effort Thrombosis I82.629 453.82

 

synonyms:

Effort Thrombosis ICD-10

  • I82.629:    Acute embolism and thrombosis of deep veins of unspecified upper extremity

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