Deep Vein Thrombosis

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Clinically Relevant Anatomy

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Mechanism of Injury / Pathological Process

A deep vein thrombosis (DVT) is a vascular disease which consists of venous stasis and hypercoagubility in the venous system and at times can become mobile and result in a pulmonary embolus and potentially death.

image: http://www.topnews.in/health/files/Deep-Vein-Thrombosis.jpg

Clinical Presentation

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Clinical Prediction Rule

The following clinical prediction rule can help a clinician identify a DVT.

1. Active cancer (treatment ongoing, within previous 6 months, or palliative)= 1 point
   
2. Paralysis, paresis, or recent plaster immobilization of the lower extremities= 1 point
   
3. Recently bedridden for > 3 days or major surgery within 4 weeks= 1 point
   
4. Localized tenderness along thte distribution of the deep venous system. Tenderness along the deep venous system is assessed by firm palpation in the cneter of the posterior calf, the popliteal space, and along the area of the femoral vein in the anterior thigh and groin= 1 point
   
5. Entire lower extremity swelling= 1 point
   
6. Calf swelling > 3 cm when compared with the asymptomatic lower extremity. Measured with a tape measure 10cm below the tibial tuberosity= 1 point
   
7. Pitting edema (greater in the symptomatic lower extremity)= 1 point
   
8. Collateral superficial veins (nonvaricose)= 1 point
   
9. Alternative diagnosis as likely or greater than that of proximal DVT. More common alternative diagnoses are cellulitis, calf strain, Baker Cyst, or postoperative swelling= -2 points
   

The total score for all items is tallied and the probability of the patients having a DVT are as follows:

0= low, 1-2=moderate,and ≥3=high³

Diagnostic Procedures

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Outcome Measures

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Management / Interventions

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Differential Diagnosis

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Key Evidence

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Resources

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Case Studies

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Recent Related Research (from Pubmed)

References

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1. Pecina MM, Bojanic I. Overuse Injuries of the Musculoskeletal System. Boca Raton: CRC Press; 1993.
   
2. Deep Vein Thrombosis. [Online image] Available at http://www.topnews.in/health/files/Deep-Vein-Thrombosis.jpg; accessed Nov 15, 2009.
   
3. Greenfield B, Tovin B. Knee. Current Concepts in Orthopaedic Physical Therapy. La Crosse: Orthopaedic Section, American Physical Therapy Association; 2001.