Thrombophlebitis (Raynaud’s Phenomenon)

Question 1

What is Thrombophlebitis?

Answer 1

The inflammation of a superficial or deep vein that leads to the formation of a thrombus

Aka deep vein thrombosis (DVT) is NOT a condition that can be treated with massage and the massage therapist’s role is to refer cases of suspected DVT

A thrombus is a clot which is fibrin-based and enmeshed in red blood cells and it is attached to the wall of the blood vessel

Once it has developed, coagulation in the slow-moving blood can cause an extension of the thrombus like a tail

The thrombus may extend for as much as 20 inches along the wall of the vein

A thrombus can form because of a combination of factors including increased coagulation of venous blood, stasis of the blood and injury to the wall of the blood vessel

The majority of thrombi (almost 95%) develop in the veins of the legs

The condition is referred to as a superficial vein thrombosis or deep vein thrombosis, depending on the vein affected

The presence of a DVT is of greatest concern

Superficial vein thrombosis is caused by irritation to the walls of the vein and presents with localized redness and warmth and a cord-like swelling along the course of the superficial vein. Pain is experienced at rest and worsens with movement. As the condition resolves, the skin may develop a brownish pigmentation along the course of the affected vein

Question 2

Causes & Contributing Factors of DVT

Answer 2

The cause of DVT is venous stasis but any increase in blood coagulation may contribute to DVT formation

Contributing factors include:

Age, generally over 40

Prolonged immobilization

Cardiac failure, stroke and heart disease

Anesthesia and surgery

Trauma

Previous history of a venous disorder

Pregnancy and postpartum

Oral contraceptive use

Diabetes mellitus

Cancer

Clotting disorder

Question 3

Symptom Picture

Answer 3

DVT can happen in any vein, however they are most common in the legs

The most common signs of DVT are those of the inflammatory process: heat, redness, swelling and deep muscle pain, as well as fever and general malaise

Pain is often described as localized, deep, aching, cramping and throbbing and is exacerbated by activity

The amount of swelling found distal to the occlusion varies, depending on the amount of blockage in the affected area

The condition can also be symptomless

The thrombus can be securely attached to the wall of the vein.
However, a serious concern with the development of a DVT is the risk that it will break free and become an embolus (mobile clot)

If the embolus enters the circulatory system it can become entrapped in the pulmonary vasculature which can lead to the obstruction of blood flow to an area of the lung

If a pulmonary embolism is present, the client will feel extreme distress and dyspnea. Sharp localized pain may be experienced in the chest and behind the sternum along with general chest discomfort

Question 4

Contraindications

Answer 4

If there is a suspected DVT, local massage and massage to the affected limb are CI’d

With a femoral fracture, both legs are CI’d

Passive and active movements are CI’d in the acute stage of DVT

If a DVT is suspected in a client already receiving treatment, treatment is discontinued

Treatment of DVT with coumadin or heparin leads to the risk of hemorrhage from any tissue or organ so consultation with their physician is necessary

Once a person has a history of DVT, they are more susceptible to developing it again, so the therapist should be aware of this

Extreme temperature contrast hydrotherapy should be avoided to the limb affected with the DVT

Heat is CI’d distal and immediately proximal to the DVT to avoid further congestion of the area

Question 5

Assessment

Answer 5

Health History Questions:

Is there a history of a recent surgery, accident, injury to blood vessels, heart disease, DVT or PE?

Have you been immobilized for a prolonged period?

Are you pregnant or postpartum?

Do you take oral contraceptives?

What is the location of the pain or cramping?

What aggravates the pain?

If the DVT is diagnosed, has massage been approved?

Observation:

May reveal signs of inflammation

Edema may be present distal to a partial or complete obstruction

Leg pallor may be noted

Palpation:

With deep palpation, there can be local tenderness when a thrombus is present

A diminished or absent dorsalis pedis pulse may be palpated

Testing

Ramirez’s test and Homan’s sign may be positive

About half of those with a DVT experience pain as a symptom, so a negative result will not necessarily rule out the presence of a thrombus