Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Hi, I Recently Had An Upper-limb DVT In The Sub-clavian
Question: Hi, I recently had an upper-limb DVT in the sub-clavian vein on the right, which presented itself as swelling and discoloration of the arm. I subsequently underwent a mechanical thrombectomy and PTA of the sub-clavian vein, which was successful. Based on the venograms, the DVT was found to be due to costoclavicular compression of the sub-clavian vein.
My question relates to the diagnosis as to the cause and the follow-up treatment, which - based on what I have read online related to upper-limb DVT's - seems unusual for my condition.
The recommended follow-up treatment was as follows:
- Prescription of Xarelto anticoagulant for 3 months,
- Physiotherapy during this period,
- To be followed up with a test to determine if the compression is still present,
- In order to determine if a 1st rib-resection should be performed.
Most of this seems reasonable, except for the physiotherapy, which relates to the diagnosis of the cause. The physiotherapy is supposed to fix "hanging shoulders" caused by poor posture. Strengthening the shoulders through physiotherapy is purportedly supposed to "lift" the shoulder and subsequently fix the compression of the sub-clavian vein.
The reason I am puzzled by this is that when I read about this condition online, I never see physiotherapy being recommended as treatment, or that DVT is caused by poor posture.
I'm a software engineer and am slender-built (about 178 cm (5.8 foot) of length and weighing 55 kg (121 pounds)). I exercise every morning by jogging a few blocks. I always ensure I maintain a good posture at my desk at work with a nice straight back, however for the last 2 - 3 months prior to the incident I was using a standing desk, standing for almost the entire duration of each work day.
I don't regard myself as having poor posture or "hanging shoulders". I did notice since being discharged from hospital that the right-hand shoulder sat considerably lower than the other one, but the physiotherapist told me that could be just due to not using the shoulder while having the arm in a sling in hospital (for controlling swelling after the operation).
I would like to know your opinion the diagnosis of "poor posture" and on performing shoulder-strengthening exercises. Will they lift the shoulder and will that possibly resolve the compression of the sub-clavian vein?
My question relates to the diagnosis as to the cause and the follow-up treatment, which - based on what I have read online related to upper-limb DVT's - seems unusual for my condition.
The recommended follow-up treatment was as follows:
- Prescription of Xarelto anticoagulant for 3 months,
- Physiotherapy during this period,
- To be followed up with a test to determine if the compression is still present,
- In order to determine if a 1st rib-resection should be performed.
Most of this seems reasonable, except for the physiotherapy, which relates to the diagnosis of the cause. The physiotherapy is supposed to fix "hanging shoulders" caused by poor posture. Strengthening the shoulders through physiotherapy is purportedly supposed to "lift" the shoulder and subsequently fix the compression of the sub-clavian vein.
The reason I am puzzled by this is that when I read about this condition online, I never see physiotherapy being recommended as treatment, or that DVT is caused by poor posture.
I'm a software engineer and am slender-built (about 178 cm (5.8 foot) of length and weighing 55 kg (121 pounds)). I exercise every morning by jogging a few blocks. I always ensure I maintain a good posture at my desk at work with a nice straight back, however for the last 2 - 3 months prior to the incident I was using a standing desk, standing for almost the entire duration of each work day.
I don't regard myself as having poor posture or "hanging shoulders". I did notice since being discharged from hospital that the right-hand shoulder sat considerably lower than the other one, but the physiotherapist told me that could be just due to not using the shoulder while having the arm in a sling in hospital (for controlling swelling after the operation).
I would like to know your opinion the diagnosis of "poor posture" and on performing shoulder-strengthening exercises. Will they lift the shoulder and will that possibly resolve the compression of the sub-clavian vein?
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome to Ask a Doctor service!
I passed carefully through your question and would explain that the compression of the vein could have been related to Thoracic outlet syndrome.
It is true that a wrong posture can lead to this situation. But, it does not seem to be your case, as you exercise regularly and maintain a regular normal position.
You should know that this syndrome can also be caused by repetitive movements. This may happen if your job requires you to repeat a movement continuously, such as typing on a computer, working on an assembly line or lifting things above your head, as you would if you were stocking shelves.
Even athletes, such as baseball pitchers and swimmers, also can develop thoracic outlet syndrome from years of repetitive movements.
Anyway, the hanging right shoulder could be related to the fact that you use it so often due to the DVT or to possible damaged nerves (related to Thoracic outlet Syndrome).
In this regard, physiotherapy can help gain the right position of the shoulder and also help reinforce the back moscles (stretching exercise).
It does not make miracles, but it can help improve your situation, coupled with anticoagulation therapy (Xarelto).
Surgery (when there is evidence of compression by the rib) may help to definitely solve the problem.
Hope you will find this information helpful!
I remain at your disposal for any further questions whenever you need!
Kind regards,
Dr. Ilir Sharka, Cardiologist
I would explain as follows:
Detailed Answer:
Hello!
Welcome to Ask a Doctor service!
I passed carefully through your question and would explain that the compression of the vein could have been related to Thoracic outlet syndrome.
It is true that a wrong posture can lead to this situation. But, it does not seem to be your case, as you exercise regularly and maintain a regular normal position.
You should know that this syndrome can also be caused by repetitive movements. This may happen if your job requires you to repeat a movement continuously, such as typing on a computer, working on an assembly line or lifting things above your head, as you would if you were stocking shelves.
Even athletes, such as baseball pitchers and swimmers, also can develop thoracic outlet syndrome from years of repetitive movements.
Anyway, the hanging right shoulder could be related to the fact that you use it so often due to the DVT or to possible damaged nerves (related to Thoracic outlet Syndrome).
In this regard, physiotherapy can help gain the right position of the shoulder and also help reinforce the back moscles (stretching exercise).
It does not make miracles, but it can help improve your situation, coupled with anticoagulation therapy (Xarelto).
Surgery (when there is evidence of compression by the rib) may help to definitely solve the problem.
Hope you will find this information helpful!
I remain at your disposal for any further questions whenever you need!
Kind regards,
Dr. Ilir Sharka, Cardiologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. Sharka,
Based on the fact that I don’t really use the right arm a whole lot more than the left arm, I believe there is a possibility that the left shoulder may also be prone to a compression.
My bone structure might be conducive to this condition and there might be a hereditary factor. I know my father might have a compression as he occasionally experiences some numbness in the fingers of the right hand, especially after intensive use of the right arm.
Would you regard it advisable to apply the exercises recommended by the physiotherapist to the left shoulder as well in order to proactively improve the situation that side?
Based on the fact that I don’t really use the right arm a whole lot more than the left arm, I believe there is a possibility that the left shoulder may also be prone to a compression.
My bone structure might be conducive to this condition and there might be a hereditary factor. I know my father might have a compression as he occasionally experiences some numbness in the fingers of the right hand, especially after intensive use of the right arm.
Would you regard it advisable to apply the exercises recommended by the physiotherapist to the left shoulder as well in order to proactively improve the situation that side?
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello again!
Thank you for the additional information!
Yes, I would recommend performing the exercises recommended by the physiotherapist in order to help reinforce the muscles and correct the position of the shoulder.
I remain at your disposal for any further questions whenever you need!
Wishing all the best,
Dr.Iliri
I would recommend as follows:
Detailed Answer:
Hello again!
Thank you for the additional information!
Yes, I would recommend performing the exercises recommended by the physiotherapist in order to help reinforce the muscles and correct the position of the shoulder.
I remain at your disposal for any further questions whenever you need!
Wishing all the best,
Dr.Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
