Vascular Disordersin SportsAmanda Tangen, ATS University of North Dakota

www.genengnews.com 

Outline What is it?

Examples

Prevention

Vascular Disorders

Vascular Disorders4 Affects: arteries, veins, and lymphatic

systems. Examples:

Deep Vein Thrombosis (DVT) Compartment Syndrome Thoracic Outlet Syndrome Sickle Cell Disease Plus many more

Deep Vein Thrombosis6,7,

33

• What is it?• Blood Clot• Most Common in Lower Extremities

• Causation• Spontaneous• Injury to the vascular wall• Alteration in blood flow• immobilization

• Symptoms• Unilateral swelling• Tension in muscles• Fevers• Erythema• Pain in area• Changes in skin

• Medical Emergency• Pulmonary Embolus (PE)• Myocardial Infarction (MI)• Thrombolytic Stroke (TS)

http://www.nlm.nih.gov/medlineplus/

Recognition and Care5,6,29

Dislodged Thrombi Medical Emergency!!

Doctor Confirmation Doppler Ultrasound CT Scan

15 Day Timeframe Don’t use most modalities

Compression Socks Anticoagulation Medication

http://www.cardiovascularaustin.com/

Deep Vein Thrombosis

Compartment Syndrome10,24,30,31

Increased Pressure within an area Compromises circulation and nerve function

Can Lead To: Muscle Death Nerve Damage

Mechanism of Injury: External Forces Hemorrhage Increase Blood Flow to Area

Most common in the Lower Extremities

What to Look For10,11,25,30

Three Types: Acute Acute Exertional Chronic

Symptoms: The 5 P’s:

Pain Paraesthesia Pallor Pulseless-ness Poikilothernia

Google Image

Compartment Syndrome

Non-Medical Emergency31,32

When is this the case? Stop Activity Elevate Extremity Ice Stretch Compartment Modify Activity

Bike/Swim instead of run Gait Analysis

Proper footwear

Compartment Syndrome

To the Doc10,11,24,25,30,31

Unsure of Diagnosis Doesn't Subside within minutes What the Doc does:

Measure Intracompartment Pressure Normal: <10 mmHg up to 20 mmHg Dangerous: 20-50 mmHg

Fasciotomy to area

Compartment Syndrome

Rehabilitation Post-Op32

Decrease Pain RICE

Increase Range of Motion Regain Strength Regain Proprioception Orthotics/Proper Footwear Cardio Fitness

Biking/Pool Workouts Walking/Jogging Progression

Compartment Syndrome

Return to Full Activity31,32

Normalized ROM and Strength No Gait Deviations Completed Jogging/Running Program

Timeframe Depends on area

8-12 weeks Post-Op

Compartment Syndrome

Thoracic Outlet Syndrome29,33

Thoracic Outlet Bordered by:

1st Thoracic Rib The Clavicle Superior border of the Scapula

TOS: Compression of the Neurovascular structures in this area Two Types:

Vascular TOS Neurogenic TOS

What to Look For29,33

Overhead athletes are an increase risk Symptoms:

Pain Numbness Weakness Fatigability Raynaud Phenomenon

Other things to look for: Poor posture/rounding of the shoulders

Main Complaint: Abduction of the arm Elevation of arm above 90 degrees

Thoracic Outlet Syndrome

Diagnosing29,33

Special Tests: Adson’s Allen’s Costoclavicular Maneuver Roo’s Test Wright’s Test Passive Shoulder Shrug Cervical Rotation Lateral Flexion Test

Look for weakened pulse, or its disappearance Inspect Posture ROM Test Strength Structural Positions

Thoracic Outlet Syndrome

Rehabilitation29,33

Physical Therapy Muscle Relaxation Stretching

Increase ROM Decrease Inflammation Attention to Posture Strengthening Joint Mobilization

Physical Therapy with Surgery Decompress the Thoracic Outlet About 3.5 months return to play time after surgery

Thoracic Outlet Syndrome

Decreasing Hypertension and Chances of

Vascular Disorders2,3,15,27

Hypertension Common precursor to vascular disorders

Healthy Diet DASH Diet

Decrease Stress Healthy Workout Regimen

Regularly, well-rounded Rid of bad habits

Prevention

Prevention as Athletic Trainers

Pre-Participation Exams Get a thorough history Get good baseline numbers

BP, pulse, respiratory rate,etc..

Being Prepared as ATC's/ATS's

Good Communication

Prevention

Review Vascular Disorders

Deep Vein Thrombosis Compartment Syndrome Thoracic Outlet Syndrome

Prevention Hypertension Pre-Participation Exam Communication

Vascular Disorders

Questions???

Citations1. The child or adolescent with elevated blood pressure. N Engl J Med. 2014 09/11;

2014/10;371(11):1074-5.2. Peripheral arterial disease. In: Harvard Medical School Health Topics A-Z. Harvard Health

Publications; 2013.3. Hypertension: Controlling the ‘silent killer’. In: Harvard Medical School Special Health

Reports. Harvard Health Publications; 2012.4. Vascular disorders. In: McGraw-Hill Concise Encyclopedia of Science and Technology.

McGraw-Hill; 2006.5. Ambruso DR, Nuss R, Wang M. Hematologic disorders. In: Hay WW, Levin MJ, Deterding

RR, Abzug MJ, editors. CURRENT Diagnosis & Treatment: Pediatrics, 22e. New York, NY: ; 2013.

6. Chesnutt MS, Prendergast TJ. Pulmonary disease. In: Hammer GD, McPhee SJ, editors. Pathophysiology of Disease: An Introduction to Clinical Medicine, 7e. New York, NY: McGraw-Hill Education; 2013.

7. Ciesla ND, Kuramoto JD. Chapter 19. physical therapy associated with respiratory failure. In: DeTurk WE, Cahalin LP, editors. Cardiovascular and Pulmonary Physical Therapy: An Evidence-Based Approach, 2e. New York, NY: The McGraw-Hill Companies; 2011.

8. Clement FM, Chen G, Khan N, Tu K, Campbell NRC, Smith M, et al. Primary care physician visits by patients with incident hypertension. Can J Cardiol. 2014 6;30(6):653-60.

9. Demorest M, Rebecca A., Washington M, Reginald L. Athletic participation by children and adolescents who have systemic hypertension. American Academy of Pediatrics [Internet]. 2013. Available from: http://pediatrics.aappublications.org.ezproxy.undmedlibrary.org/content/125/6/1287.long.

10. Haller PR. Chapter 275. compartment syndrome. In: Tintinalli JE, Stapczynski JS, Ma OJ, Cline DM, Cydulka RK, Meckler GD, et al, editors. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. New York, NY: The McGraw-Hill Companies; 2011.

11. Hirth CJ. Rehabilitation of lower-leg injuries. In: Hoogenboom BJ, Voight ML, Prentice WE, editors. Musculoskeletal Interventions: Techniques for Therapeutic Exercise, 3e. New York, NY: McGraw-Hill Education; 2013.

12. Igor Mitrovic M. 11: Cardiovascular disorders: Vascular disease. In: Hammer G.D. MSJ, editor. Pathophysiology of Disease: An Introduction to Clinical Medicine. 7th ed. New York, NY: McGraw-Hill; 2013.

13. Kemp WL, Burns DK, Brown TG. Chapter 9. vascular pathology. In: Pathology: The Big Picture. New York, NY: The McGraw-Hill Companies; 2008.

14. Kevin M. Conley, PhD, ATC* (Chair), Delmas J. Bolin, MD, PhD, FACSM†, Peter J. Carek, MD, MS‡, Jeff G. Konin, PhD, PT, ATC, FNATA, FACSM§, Timothy L. Neal, MS, ATC, Danielle Violette M, ATC. National athletic trainers’ association position statement: Preparticipation physical examinations and disqualifying conditions  [Internet]. 2014.

15. Leddy JJ, Izzo J. Hypertension in athletes. The Journal of Clinical Hypertension. 2009;11(4):226-33.

16. MD Baggish AL. Blood pressure and left ventricular hypertrophy during american-style football participation. Hypertension [Internet]. 2013. Available from: http://circ.ahajournals.org.ezproxy.undmedlibrary.org/content/128/5/524.long.

17. MD Balady GJ, MD Drezner JA. Tackling cardiovascular health risks in college football players. Circulation [Internet]. 2013. Available from: http://circ.ahajournals.org.ezproxy.undmedlibrary.org/content/128/5/477.full.

18. MD M, Tara, MD P, Art. Deep vein thrombosis. . 2013.19. Mitrovic I. Cardiovascular disorders: Vascular disease. In: Hammer GD, McPhee SJ, editors.

Pathophysiology of Disease: An Introduction to Clinical Medicine, 7e. New York, NY: McGraw-Hill Education; 2013.

Citations Continued

20. Ong H. THe jnc 7 hypertension guidelines—reply. JAMA. 2003 September 10;290(10):1312-.21. Patel DR. Chapter 16. hematologic conditions. In: Patel DR, Greydanus DE, Baker RJ, editors. Pediatric

Practice: Sports Medicine. New York, NY: The McGraw-Hill Companies; 2009.22. PhD MC, Noah, MD Fox LP, MD, MPH Goldsmith, Lowell A., MD Tharp MD. Raynaud's phenomenon. .

2013.23. Sass AE, Kaplan DW. Adolescence. In: Hay WW, Levin MJ, Deterding RR, Abzug MJ, editors. CURRENT

Diagnosis & Treatment: Pediatrics, 22e. New York, NY: ; 2013.24. Simon RR, Sherman SC. Chapter 15. upper arm. In: Emergency Orthopedics, 6e. New York, NY: The

McGraw-Hill Companies; 2011.25. Simon RR, Sherman SC. Chapter 4. complications. In: Emergency Orthopedics, 6e. New York, NY: The

McGraw-Hill Companies; 2011.26. White WB, Turner JR, Sica D, Bisognano JD, Calhoun DA, Townsend RR, et al. Detection, evaluation, and

treatment of severe and resistant hypertension proceedings from an american society of hypertension interactive forum held in bethesda, maryland, USA, october 10th2013. Journal of the American Society of Hypertension(0).

27. Wilson PE, Clayton GH. Rehabilitation medicine. In: Hay WW, Levin MJ, Deterding RR, Abzug MJ, editors. CURRENT Diagnosis & Treatment: Pediatrics, 22e. New York, NY: ; 2013.

28. Kyrle, Paul A, & Eichinger, Sabine. Deep vein thrombosis. The Lancet, 365(9465), 1163-1174. 2005. 29. Dutton M Dutton, Mark.. Chapter 25. The Cervical Spine. In Dutton M. Dutton M Ed. Mark Dutton. (Eds),

Dutton's Orthopaedic Examination, Evaluation, and Intervention, 3e. Retrieved April 22, 2015 from http://accessphysiotherapy.mhmedical.com.ezproxy.undmedlibrary.org/content.aspx?bookid=475&Sectionid=40791222. 

Citations Continued

30. Nordquist E. Complications. In: Sherman SC. eds. Simon’s Emergency Orthopedics, 7e. New York, NY: McGraw-Hill; 2014. http://accessphysiotherapy.mhmedical.com.ezproxy.undmedlibrary.org/content.aspx?bookid=1132&Sectionid=64413985. Accessed April 22, 2015. 

31. Patel DR, Lyne E. Chapter 29. Overuse Injuries of the Leg, Ankle, and Foot. In: Patel DR, Greydanus DE, Baker RJ. eds. Pediatric Practice: Sports Medicine. New York, NY: McGraw-Hill; 2009. http://accessphysiotherapy.mhmedical.com.ezproxy.undmedlibrary.org/content.aspx?bookid=450&Sectionid=40190625. Accessed April 22, 2015. 

32. Hirth CJ. Rehabilitation of Lower-Leg Injuries. In: Hoogenboom BJ, Voight ML, Prentice WE. eds. Musculoskeletal Interventions: Techniques for Therapeutic Exercise, Third Edition. New York, NY: McGraw-Hill; 2013. http://accessphysiotherapy.mhmedical.com.ezproxy.undmedlibrary.org/content.aspx?bookid=960&Sectionid=53549694. Accessed April 22, 2015

33. Chandra, Venita, Little, Christine, & Lee, Jason T. (2014). Thoracic outlet syndrome in high-performance athletes. Journal of Vascular Surgery, 60(4), 1012-1018.

Citations Continued