intramuscular thrombus following calf injuries

[Sandra St Cyr]

Hi Steve
Lately I’m noticing occlusive intramuscular thrombus fairly commonly post calf injuries, most recently 2 days ago and the injury was 3 days prior resulting in small partial tears and “bullnozing” of distal mhg but no aponeurosis injury. The thrombus was more proximal in the MB in this recent case, and was seen by chance, although the patient was point tender there. It was not my case, I was helping out after the fact, so it can be easy to miss important info. I have seen 5 cases of intramuscular thrombus in the past year and the injuries varied from achilles rupture to soleus or gastroc tears. In two cases there was propogation into the peroneal veins.
What is your experience?

thanks so much
Sandy

[Stephen Bird]

Hi Sandy,

You make a very good observation here and I think it is mandatory that whenever you see a lower limb muscle injury like a medial gastrocnemius tear, solar tear or Achilles injury that we perform a basic DVT examination of the adjacent veins and also the popliteal vein to check for DVT.

It all comes back to old fashioned medicine and Virchows Triad.

Virchows Triad is the risk factors for developing a clot.

The triad consists of:

Trauma
Stasis
Hypercoagulatable state

In the case of a medial gastrocnemius tear for example you have just created 2 of these conditions.

There is the trauma of the injury and also the stasis caused by the injury which means you will not be moving freely and may immobilise the limb.

Hence you have created a great situation to form a DVT.

In terms of the patients global health you could well argue diagnosing the MSK tear is important, however diagnosing the DVT is even more important.

The muscle tear is painful and an inconvenience, however a DVT and pulmonary embolus may be lethal.

Steve

[Sandra St Cyr]

thanks Steve, that’s very helpful

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