Effort Thrombosis in Sports

ExitCare ImageRepetitive and vigorous activity or trauma may cause a blood clot (thrombus) to form in the veins of the upper extremities. This condition is known as effort thrombosis. Effort thrombosis may result in fatigue, heaviness, pain, weakness, and swelling of the upper extremity (hand, forearm, arm, and shoulder).

SYMPTOMS

  • Fatigue (especially with activity).

  • Numbness and heaviness of the upper extremity.

  • Dull, aching pain.

  • Arm cramps.

  • Swelling of the upper extremity with dilated superficial veins (engorged veins near skin surface).

  • Poor circulation characterized by coldness, swelling, and blue discoloration in the hands and fingers.

  • Tenderness in the armpit.

CAUSES

The symptoms are caused by the formation of a clot in the main deep vein of the upper extremity. The clot is caused by damage to the vein from overuse of the upper extremity or compression of the vein by other internal structures (tendons, the first rib, or the clavicle).

RISK INCREASES WITH:

  • Prolonged periods of inactivity.

  • Dehydration.

  • Oral contraceptive medications.

  • Sports requiring repetitive overhead activities (baseball, volleyball, or tennis).

  • Blood clotting disorder or previous history of blood clots.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Cardiovascular fitness and strength.

  • Flexibility.

  • Endurance.

  • Maintain hydration by drinking plenty of fluid during physical activity.

  • Use alternative forms of contraception

PROGNOSIS

This condition is treatable with appropriate measures, including medications, with resolution of symptoms within 1 week. Often some residual symptoms persist.

RELATED COMPLICATIONS

  • Permanent numbness or loss of arm or hand strength.

  • Chronic disability, aching, muscle cramping, or fatigue of the upper extremity.

  • Recurrence of a clot.

  • Death as a result of a clot breaking off and going to the lungs (pulmonary embolism).

  • Stroke as a result of the clot breaking off and going to brain.

  • Bleeding at other parts of the body due to treatment with blood thinners.

TREATMENT

Initially treatment typically involves rest, applying heat to the affected area, and elevation of the involved extremity. Medication may be given to break up the clot or thin the blood. Surgery is rarely necessary to remove the clot.

MEDICATION

  • If pain medication is necessary, nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • A caregiver may prescribe blood-thinning medication (heparin, warfarin, or aspirin). These medications should be stopped if any bleeding, upset stomach, or signs of an allergic reaction occur.

  • Thrombolytic agents (clot busting medication) may also be prescribed

SEEK MEDICAL CARE IF:

  • Symptoms worsen or do not improve in 1 week despite treatment.

  • There is any sign of progression of the clot.

  • You experience shortness of breath or chest pain.

  • You experience signs of a stroke:

  • Headache that steadily worsens.

  • Drowsiness.

  • Unconsciousness.

  • Change in the size of pupils.

  • Vomiting.

  • Inability to move arms and legs equally well on both sides.

  • Stiff neck.

  • Convulsions.

  • Noticeable restlessness.

  • Confusion, disorientation, or mental status changes.

  • You experience evidence of bleeding while taking blood thinners or thrombolytic agents, including bloody stools, black and tarry stools, coughing up or spitting up of blood, or recurrent bloody nose.