Unique treatment regimen for effort thrombosis in the nondominant extremity of an overhead athlete: a case report.
OBJECTIVE
To advise athletic trainers on the potential for effort thrombosis to occur in nonthrowing athletes and to underscore the importance of early recognition and treatment.


BACKGROUND
An 18-year-old offensive lineman presented with a 1-day history of diffuse shoulder pain with no specific history of injury; swelling and erythema involved the entire left upper extremity. He was immediately referred to the team physician, who suspected deep vein thrombosis and sent the athlete to an imaging center. Duplex ultrasound was obtained on the day of presentation, and he was admitted to the hospital that evening.


METHODS
Deep vein thrombosis, thoracic outlet syndrome, shoulder tendinitis.


METHODS
Anticoagulation with heparin was administered at the hospital, and he was sent home the next day on subcutaneous enoxaparin sodium, followed by a 5-mg daily dose of oral warfarin sodium. Oral anticoagulants were continued for a total of 4 weeks. The athlete began upper body lifting and was released 5 weeks postinjury to gradually return to football without restrictions.


RESULTS
Effort thrombosis is typically seen in the dominant arm of athletes, and the current treatment protocol calls for thrombolysis or surgical intervention. This athlete, whose position required repeated elevation of his arms in forward flexion, sustained the injury in his nondominant arm, was treated with anticoagulation only, and had a full return to football. At 18-month follow-up, he had no recurrence of symptoms.


CONCLUSIONS
Early recognition and treatment of athletes with effort thrombosis is paramount to a successful clinical outcome and prompt return to play.
Snead
Dale
D
Methodist Sports Medicine Center, Indianapolis, Indiana 46280, USA.
Marberry
Kevin M
KM
Rowdon
Greg
G
D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D017984:Enoxaparin / Q000627:therapeutic use; D005538:Football / Q000293:injuries*; D006801:Humans; D008297:Male; D020069:Shoulder Pain / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000628:therapy; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000628:therapy; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D017984:Enoxaparin; D014859:Warfarin