Ulnar Deep Venous Thrombosis in a Professional Baseball Pitcher
The repetitive motions in overhead throwing place athletes at risk for specific injuries to the dominant shoulder and elbow. Although uncommon, vascular injuries must be con- sidered in this differential. Examples of these are digital vessel thrombosis, proximal arterial thrombosis with distal embolization, vessel aneurysm, and vessel compression.7 Paget-Schroetter syndrome, or effort thrombosis, is well described and refers to spontaneous axillosubclavian vein thrombosis secondary to mechanical compression in the cos- toclavicular space.11 Multiple case series exist in the litera- ture regarding Paget-Schroetter syndrome in young, healthy athletes.6,16,17,22,26 It is important, however, to differ- entiate axillosubclavian vein thrombosis from a distal deep venous thrombosis (DVT). To our knowledge, there are no reported cases of deep venous thrombosis occurring distal to the elbow in throwing athletes. The purpose of this article is to report a case of ulnar vein thrombosis in a professional baseball pitcher and to provide a management model.
First, it appears that rapid diagnosis and prompt treatment from a multidisciplinary medical team resulted in no time lost from competition. Second, we recommend avoiding extended use of a compressive sleeve after pitch- ing, given that this may contribute to venous stasis. Finally, the possibility exists that this problem may go undiagnosed, with resolution or subclinical embolization before recognition. Conversely, embolization may occur even when the condition is promptly recognized and treated. It is still important to initiate and complete treat- ment to prevent recurrence and PTS. In our opinion, this case demonstrates a challenging clinical problem that was successfully managed with extrapolation of evidence-based medicine from multiple disciplines.
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