Deep Vein Thrombosis: How to manage

Background
Last week I was evaluating a patient 12-weeks status post rotator cuff repair. In general, the patient is progressing in her strength and function as expected. Prior to the start of the session, the patient reported she was recently having "tightness" in her calf. She denied any recent change in activity (in the past two weeks) and The reported she is an active smoker and has a history of hypertension. Below is a picture of her calf

My Examination and Treatment
Whenever someone states they have calf pain, a deep vein thrombosis (DVT) is always on my radar. Following visual inspection, I palpated the lower extremity and found a taut band running along her calf. Further examination revealed localized tenderness, calf swelling, and venous distension. The patient denied any recent shortness of breath, nausea, light headedness, dizziness, or feeling faint. (These questions are important because they assist in ruling out a pulmonary embolism, which is an emergency situation.) 

In assisting my diagnosis, I used the Well's DVT rule (seen below). 

My Score:
+1: Recent general anesthesia in 12 weeks
+1: Calf swelling >3 cm
+1: Localized tenderness along the deep venous system
+1: Collateral superficial veins 

My patient scored a 4 on the Well's DVT rule. Due to the high likelihood of a DVT I told my patient to go to the emergency room for appropriate testing. Since she was not having any immediate symptoms, I told the patient she drive herself to the hospital.

Review the DVT criteria below. Blood clots are relatively uncommon in the outpatient orthopedic setting, but they do happen on occasion. Make sure you know how to treat these problems accordingly. 


- Jim  

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Brian Duncan from OPTIM PT performing the CTJ Closing Manipulation

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