Upper Extremity Superficial Vein Thromboses Presenting as Acute Neck Pain in a Young and Healthy Male: A Case Report.
Kristen L Zosel, Max K Dummar, Benjamin G Adams and 2 others
PMID 34123537WHAT IT FOUND
A young soldier's acute neck pain was musculoskeletal in appearance but resistant to therapy.
A rising blood pressure trend and an elevated D-dimer prompted referral, revealing superficial vein thromboses likely caused by prolonged crutch use. This case highlights that unexplained pain worsening despite care warrants vital sign review.
Key findings
01The subject's neck pain was initially assessed as musculoskeletal with no obvious red flags, but worsened despite manual therapy and dry needling.
02A subtle upward trend in blood pressure over three months and an elevated D-dimer result triggered a referral for ultrasound, which diagnosed superficial vein thromboses.
03The thromboses were attributed to repetitive upper extremity stress from bilateral axillary crutch use following a prior lower extremity injury.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This is a single case report, so it cannot establish how common this presentation is or prove that vital sign review will always catch such cases. The patient had access to a military healthcare system with immediate access to all past medical records and vital signs. Civilian therapists may not have this data available unless they actively measure vitals themselves. The initial presentation lacked the classic signs of thrombosis (edema, erythema, palpable cord), making it an atypical case.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not assume that neck pain with no visible swelling or redness is always musculoskeletal. This patient had no local signs of thrombosis; the clue was a systemic trend (rising blood pressure) and a lab value (D-dimer) that required reviewing the medical record when the patient did not improve.