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Vein Problems Lead to Athletic Fractures

Tiny fractures and other rib deformities have been seen in patients undergoing treatment for circulatory problems.  This is very common among athletes who play sports that require heavy use of their upper extremities.

Paget-Schroetter syndrome—also referred to as venous thoracic outlet syndrome or sub-clavian vein effort thrombosis—is a condition wherein there is an obstruction of the vein responsible for carrying the blood to the heart from the arms.  This vein runs over the first rib and under the collarbone, which makes it more susceptible to compression. Vein compression is particularly common when there is repeated stress on the arm while it is in an elevated position. Such patterns have allowed doctors to diagnose many athletes with common vein problems.

Robert W. Thompson, M.D., Director of the Center for Thoracic Outlet Syndrome and Professor of Surgery at the Washington University of St. Louis, revealed that patients who seek of treatment for these kinds of vein problems are typically physically active and otherwise healthy young adults. But they suddenly experience swelling in their arms, which sometimes causes the entire limb to appear bluish and grow to be several times its normal size. Usually a simple x-ray exam would find that the abnormal vein function also caused rib deterioration, calcification and miniscule fractures along the first rib.

According to Dr.Thompson, frequent repetition of arm movements can cause first-rib microfractures. Vein thickening near the first rib occurs much as a callous might develop on overused hands. He further said that, under these circumstances, there is a possibility that solidification can happen, which can take up space and apply more pressure to the vein. So far, report of these types of incidents among venous thoracic outlet patients is limited.

Medication and other treatment remedies can be started to solve these vein problems. Any blood clots formed should be broken up to relieve pressure. In addition, surgery is often necessary to open up space for blood to flow freely through the vein and into the heart. If other options fail, the whole first rib is sometimes removed as another remedy.

The Journal of Vascular Surgery reported that, in a study, 37 patients were given surgery to treat their vein problems.  Dr. Thompson said that of this group of individuals, almost half, 16, had microfractures along the first rib that had previously gone undetected. Among individuals of the group that were older at 30 years old, 76 percent were diagnosed with microfractures. It was clear that the microfractures had an effect on the blood flow from the arm to the heart.

Dr. Thompson and his research team treat three types of thoracic outlet syndrome (TOS): venous thoracic outlet syndrome, neurogenic thoracic outlet syndrome and arterial thoracic outlet syndrome. Neurogenic thoracic outlet syndrome is the most common subtype; it occurs when there is pressure on the nerves under the collarbone. Arterial thoracic outlet syndrome is the rarest of the three. Many times, invasive surgery is required to treat any of these vascular conditions. Over time, as more rib samples are collected through various surgeries, researchers will undoubtedly find out more about these microfractures and their related vein problems. For more information about veins, you can contact a vein doctor in your community.

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