title: Unique treatment regimen for effort thrombosis in the nondominant extremity of an overhead athlete: a case report.
abstract: 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.
authors.affiliation: Methodist Sports Medicine Center, Indianapolis, Indiana 46280, USA.
authors.forename: Dale
authors.initials: D
authors.lastname: Snead
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Marberry
authors.forename: Greg
authors.initials: G
authors.lastname: Rowdon
mesh_terms: 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
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D014859:Warfarin