Upper extremity deep vein thrombosis in orthopaedic and trauma surgery: a systematic review

Upper extremity deep venous thrombosis (DVT) is considered a rare phenomenon. Little is known as to what factors may contribute to the development of upper extremity DVT following trauma or elective orthopaedic surgery. The incidence of pulmonary embolism (PE) related to upper extremity thrombosis is reported as 12 to 36%, where up to 16% of cases are fatal. The purpose of this paper was to systematically review the literature to assess all cases of upper extremity DVT presented in the literature in order to determine epidemiology and outcome. A review of EMBASE, Medline, CINAHL and AMED from their inception to November 2009, sources of grey literature and a pertinent hand search of specialist orthopaedic journals was undertaken. A total of 38 cases of upper extremity DVT and 19 cases with PE were identified from 20 publications. The incidence of upper extremity DVT and PE was greatest in cases following shoulder surgery. There did not appear to be any greater risk in patients with diabetes or obesity. In total, one patient died after a PE following shoulder surgery. Although a relatively uncommon complication, the literature suggests that upper extremity DVT can lead to PE, which should be considered by orthopaedic clinicians in patients following upper extremity surgery or trauma.