Upper extremity thrombosis presenting as medial elbow pain after shoulder arthroscopy.

Moiz I Manaqibwala,Alan S Curtis,Irene E Ghobrial

doi:10.1155/2014/653146

Abstract

Deep vein thrombosis of the upper extremity is believed to be an uncommon complication of arthroscopic shoulder surgery. It most commonly presents with significant swelling and pain throughout the upper extremity. However the diagnosis can be easily missed when findings are more subtle and unrelated or the patient asymptomatic. In this study we report on 5 cases of postoperative upper extremity deep vein thrombosis (UEDVT). Each case was performed in the lateral decubitus position with an interscalene block and postoperative sling immobilization. All patients presented with a primary complaint of medial elbow pain and went on to require anticoagulation. Only one patient was found to have a heritable coagulopathy. The true incidence of thromboembolic phenomena after shoulder arthroscopy may be higher than that reported in the current literature. Therefore a high index of suspicion must be maintained when evaluating patients postoperatively to avoid misdiagnosis. Symptoms of medial elbow pain after immobilization in a sling should be considered an indication for duplex ultrasound evaluation. Ultimately, further prospective study is needed to better understand the prevalence, prevention, and management of this entity.

Highlights

Deep vein thrombosis (DVT) is a well-known complication following orthopaedic surgery
Most cases typically involve the lower extremities; 11% percent of all DVT are known to occur in the veins of the arm and forearm [1]
Our case series illustrates how the presentation for upper extremity deep vein thromboses (UEDVT) after shoulder arthroscopy can be fairly innocuous, and a greater incidence might be seen if a high index of suspicion is maintained

Summary

Introduction

Deep vein thrombosis (DVT) is a well-known complication following orthopaedic surgery. Most cases typically involve the lower extremities; 11% percent of all DVT are known to occur in the veins of the arm and forearm [1]. These upper extremity deep vein thromboses (UEDVT) are well described in the literature [2,3,4,5]. Weakness, and visible venous collaterals are seen as well [4] In this case series we seek to illustrate that even innocuous appearing medial elbow pain can be a primary presenting feature for UEDVT after shoulder arthroscopy

Case Presentation

Findings

Discussion