BCA

Muscle tear….or DVT?

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I’ve just done my first Parkrun. For those that don’t know anything about Parkrun, it is a free, community-led international event that happens somewhere near you on a Saturday morning. It is a 5kilometre run, which is timed. It felt like hard work, and I got too hot as I had kept my fleece on, which was obviously a mistake.  I’ll let you know what my time was at the end! Parkrun has turned exercise back into what it should be: done by all, easy to access and free. Here is a link to the Abingdon Parkrun

Anyway, after the run I saw one or two participants stretching their calf muscles with rather pained faces. Presumably they had simply pulled a muscle in the leg. A bit of stretching and a mix of exercise and rest, and they’ll be fine. One of the dilemmas that clinicians have is whether leg pain like this is just a pulled muscle or is a DVT, particularly if the patient has not been doing any exercise that might have injured a muscle. I saw one such patient a couple of weeks ago who had pain in his lower leg. He hadn’t done any vigorous exercise and the leg was a bit swollen. I wondered whether he had a deep venous thrombosis (DVT)?

A DVT is a clot of blood (or thrombus)  in one of the veins. The blood clot prevents blood flowing through the vein, hence the swelling. The worry about a DVT is that some of the thrombus can break off and travel through the heart and then get lodged in one of the pulmonary arteries that carry blood to the lungs, called a pulmonary embolism (PE). This is why you don’t want to massage the leg of someone who possibly has a DVT.   PE can cause shortness of breath and chest pain and is a cause of death. So we do need to know if these patients have a DVT or not. If they do then they need to be treated with an anticoagulant, quite typically apixaban (Eliquis).

The way that we can check to see if someone has a DVT is to use an ultrasound scanner to see whether the vein can be squashed. Arteries have tough walls and should not be squashable with compression. Veins have thin walls and should normally be squashable, a bit like a slightly flat bike tyre. If a vein has thrombus in it, it can’t be squashed, a bit like an overinflated tyre. You can see the arteries  in this video. They can’t be squashed. That’s normal. The veins are just above the arteries and in the video you can see that the vein in the right leg can be squashed. The vein in the left leg can’t be squashed because there is thrombus in it. This patient did have a DVT in his left leg.

The GP was very helpful and put him on apixaban and sent him to the Churchill hospital, where the DVT was confirmed. The anticoagulant will minimise the risk of him dying from a pulmonary embolism. Good result!

I hope that the Parkrunners who had calf muscle twinges all recover quickly. I came 222nd out of a field of 316 and did the run in 30mins 39secs. Not at all fast, but I enjoyed it, and will do it again. But if the weather is mild, I’ll leave my fleece off! There was a great sense of community. Maybe I’ll see you there one day?

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