Formation of Clot in the Arm Vein and Arm Pain

Deep vein thrombosis (DVT) is the formation of clots in deeper veins (veins) in our body, not just under the skin. Deep veins are located side by side with arteries (arteries) of the same name.

Clot formation is a reaction required for the interruption of the blood flow out of the vein due to reasons such as injury under normal conditions, that is, to stop the bleeding. However, as a result of various triggering factors, blood clots can also occur in the vein. Clots formed in the vein may break off where they form or from where they formed, leading to a decrease or cessation of blood flow in a different region.

Clots formed in the deep veins can break off from the place where they first formed and be carried by the circulation and block the pulmonary vessels. This is called pulmonary thromboembolism (PTE). Generally, pulmonary thromboembolism is caused by clots in the calf and thigh veins, but it can also be caused by clots in the arm veins. About 10% of all deep vein thrombosis occur in the arms. Most of them take place in the axilla and near the neck, called the subclavian.

Symptoms of Clot Formation in the Arm Vein

The occurrence of deep vein thrombosis in the arm leads to ambiguous complaints that can occur in many other problems. Therefore, it can be difficult to diagnose. It can cause symptoms such as unilateral shoulder pain, neck pain, swelling in the hand or arm, edema, bruising on the skin, pain along the arm and forearm, and weakness in the hand. These symptoms can be confused with problems such as neck hernia , shoulder muscle and tendon injuries . If the superior vena cava vein, which allows blood to return to the heart, is affected, there may be facial blood pooling and edema of the chest wall. To compensate for the occluded vein, the superficial veins under the skin may enlarge and become prominent on the anterior side of the shoulder and chest. This is called the Urschel sign.

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Why Does It Happen?

Heavy physical activities can cause damage to the inner surface of the vessels and trigger clot formation. Apart from compelling movements such as rowing and throwing a ball, activities such as carrying a heavy bag can also cause this. Clot formation in the arm veins due to compulsive and repetitive motion is also called Paget-Schroetter syndrome. Responsible for 10-20% of all DVTs in the arm, this mechanism mostly occurs in otherwise healthy young athletes. Structurally, an extra rib bone protruding from the neck vertebrae in the upper part of the chest (cervical rib) or the overdeveloped neck muscles may increase the risk of damage to the vessels in compelling physical movements.

Fractures in the arm (humerus), collarbone (clavicle), ribs or damage to neighboring muscles can also damage the surrounding vessels and cause DVT to develop.

Medical procedures such as pacemaker insertion, central venous catheter placement may increase the risk of clot formation in the arm and neck veins. The majority of DVTs in the arm veins develop in association with such medical interventions.

A patient presenting to the doctor with swelling and bruising on the right arm. As a result of examination and tests, subclavian vein thrombosis secondary to thoracic outlet syndrome was detected. Source:  evtoday.com

In the problem called thoracic outlet syndrome, the blood vessels and nerves that leave the chest and go to the neck and arm are compressed between the rib bones or muscles.

Genetic diseases or mutations that cause blood to clot more easily than normal may be responsible for the development of DVT.

Read More  Thoracic Outlet Syndrome

Cancer and various rheumatic diseases can cause clot formation. Sometimes a clot can be detected in the arm vein before the diagnosis of cancer is made.

In some of the patients, no reason may be found for the development of DVT.

Diagnosis

Diagnosis is made by imaging methods that support appropriate medical history and physical examination findings. Ultrasonography, computed tomography and magnetic resonance imaging methods can be used for diagnosis.

Treatment

Blood thinners (anticoagulant) drugs are used in the treatment. One of the old blood thinners, warfarin drug can be preferred. While taking warfarin, blood clotting time should be checked regularly. Thus, the dose is adjusted according to the individual. Some newer blood thinners can be used without the need for continuous testing. These are drugs with active ingredients apixaban, rivaroxaban and edoxaban. Depending on the location and severity of the clot, blood thinning treatments can be used for 1 to 6 months.

If the clot poses a life-threatening risk, clot-busting (thrombolytic) treatments can be given. The clot-dissolving drug can be administered directly to the site of the clot with a vein or an intravenous catheter. Since this treatment carries risks such as internal bleeding and cerebral hemorrhage, it is not applied to every patient.

In severe cases, the blood vessel can be opened by physical intervention to the clot with surgery or angiography (catheter).

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