Sudden swelling and pain in the upper extremities

Introduction Sudden swelling and soreness in the upper limbs is one of the symptoms of deep venous thrombosis in the upper extremities. Upper extremity swelling is the earliest symptom that extends from the finger to the upper arm to the entire upper limb, and is more severe in the proximal side. Pain can occur at the same time as swelling, or it can only manifest as soreness, increased in the upper limbs, and sometimes in the form of a cord-like, tender thrombus. About 2/3 of the patients had venous congestion and the affected limbs changed in purple or blue-purple. The cause of the disease is divided into intravascular factors such as the position change or strong activity of the upper limb, causing the blood vessel to be compressed. Extravascular factors such as intubation into the blood vessels, steel wire, irritant drug injection, etc.

Cause

1. The primary cause of the disease: the primary cause of the disease is outside the blood vessels. Generally, due to the change of body position or strong activity of the upper limb, the blood vessel is compressed, and the thoracic outlet compression sign may be accompanied by or without an anatomic abnormality. For example, when the subclavian vein passes through the rib cage triangle, it is compressed by the rib cage ligament, the subclavian muscle, the anterior scalene muscle, and the protruding scalene nodules. When the upper limbs do strong activities (swim, climb, weightlifting, Softball, tennis, etc., or the unaccustomed movements of the upper limbs caused by certain occupations, can cause repeated injury of the subclavian vein and thickening of the intima, eventually leading to thrombosis, which is known as Paget-Schroetter syndrome. Also known as "frustrated" intravenous thrombosis.

2. Secondary causes of pathogenesis: There are many secondary causes, such as catheters, wires, and irritant drug injections in the blood vessels. After venous catheterization, about one-third of patients can develop thrombosis, of which 1% to 5% have clinical symptoms. In addition, there are heart failure, pregnancy, oral contraceptives, coagulation and fibrinolysis dysfunction, hemodialysis of arteriovenous fistulas. Other causes of the disease are extravascular, such as cancer, radiation therapy, first rib or clavicle fracture.

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Men, women and any age can be affected. Secondary causes often have traceable causes; while Paget-Schroetter syndrome is more common in young and middle-aged men, and 2/3 lesions occur in the right upper limb, which may be related to more exertion of the right upper limb. 4/5 patients had a history of frustration 24 hours before onset, strong activity in the upper extremities or prolonged upper limbs in an unaccustomed position. About 1/10 of the patients had no incentives, but after a night of sleep, wake up in the morning Find.

Upper limb swelling, pain, skin bruising and superficial varicose veins are the four main symptoms. Upper extremity swelling is the earliest symptom that extends from the finger to the upper arm to the entire upper limb, and is more severe in the proximal side. Pain can occur at the same time as swelling, or it can only manifest as soreness, increased in the upper limbs, and sometimes in the form of a cord-like, tender thrombus. About 2/3 of the patients had venous congestion and the affected limbs changed in purple or blue-purple. Superficial varices are formed more than 1 to 2 days later, with the shoulder and upper arm being the most obvious. Acute symptoms such as swelling and pain in most patients may resolve spontaneously in a few days or weeks, but it is still difficult to achieve complete recovery. More than 2/3 of the patients have residual lesions, showing varying degrees of swelling and soreness, or Swelling and pain after the activity.

According to the sudden onset of swelling and pain in the upper limb, a preliminary diagnosis can be made, but venography is the most reliable diagnostic method. Although non-invasive examination techniques have developed rapidly in recent years, because the subclavian vein is covered by the clavicle, dual-function Doppler scanning and nuclear magnetic resonance are often difficult to accurately determine thrombotic lesions in the subclavian vein. Suspicious patients were screened by various non-invasive examinations. Patients with direct signs without lesions should be examined at the same time and compared with the affected side. Passman compared the upper extremity veins of a group of hemodialysis patients with a double-function ultrasound and venography. The sensitivity and specificity of the double-function ultrasound diagnosis of upper extremity venous occlusive disease were 81% and 97%, respectively. If the results of the ultrasound examination are not clear, venography will be performed.

Differential diagnosis

Differential diagnosis of sudden swelling and soreness in the upper limb:

1, upper limb edema: breast cancer is one of the most common malignant tumors in women in China. With the advancement of medical technology, the therapeutic effect of breast cancer has been significantly improved, and a considerable number of patients are expected to achieve long-term survival. However, it should not be overlooked that the treatment of sequelae affects the quality of life of patients to varying degrees. Upper extremity edema is the most common, and edema can cause upper limb dysfunction such as shoulder movement limitation, limb weakness, numbness, pain and other abnormalities, which seriously affect the daily life of the majority of patients.

2, the limbs often have numbness on the far side: the limbs often have numbness on the far side is a symptom of neuroma. Neuroma usually refers to schwannomas from nerve sheath tissue, most of which are located in the limbs, armpits, and also on the clavicle, neck and other parts. It is a benign tumor with slow growth and generally no recurrence after resection. Located in the limb mass, it is fusiform, and its nerves often have numbness, pain, and hyperesthesia on the far side of the dominant limb. Compression of the tumor can also cause numbness.

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