This Presentation will inform you about Deep Vein Thrombosis. This will give you awareness on virchows triad. This will throw light on pathophysiology & clinical manifestation of DVT. This will give you the knowledge on diagnosis of DVT. This ppt will bring the cup of knowledge on physiotherapy assessment & management of DVT

1. DEEP VEIN THROMBOSIS
DR. ANERI PATWARI
MPT-CARDIORESPIRATORY
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2. VENOUS THROMBOEMBOLISM
(VTE)
• Venous thromboembolism (VTE) A condition in which a blood clot
(thrombus) forms in a vein, which in some cases then breaks free and enters
the circulation as an embolus, finally lodging in and completely obstructing
a blood vessel, e.g., in lungs causing a PE (PULMONARY EMBOLISM)
• The most common type of venous thromboembolism is DEEP VEIN
THROMBOSIS, which occurs in veins deep within the muscles of the
leg,arm and pelvis.
• A superficial venous thrombosis (also called phlebitis or superficial
thrombophlebitis) is a blood clot that develops in a vein close to the surface
of the skin. These types of blood clots do not usually travel to the lungs
unless they move from the superficial system into the deep venous system
first.
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4. VTE OCCURS AS A RESULT OF
“VIRCHOW’S TRIAD” IS A COMBINATION
OF
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5. DVT
• Dvt(deep vein thrombosis) commonly occurs in lower extremities (calf
& thigh), but also occur in upper extremities.
• The primary pathophysiological concern associated with dvt is
immobilization.
• Dvt itself can also result in peripheral vascular compromise, infection
& venous gangrene.
• Post-thrombotic syndrome is a chronic complication of dvt, damage to
venous valves result in venous pooling.
• The superficial femoral and popliteal veins in thighs and posterior
tibial and peroneal veins in calves are most commonly affected
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11. TERMINOLOGIES
• Thrombophlebitis a thrombus accompanied by
inflammation of the vein (phlebitis).
• Phlebothrombosis - refers to a thrombus with minimal
inflammation.
• Dislodgment and migration of a thrombus are known as
thromboembolism. Which is common in
phlebothrombosis.
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12. CLINICAL MANIFESTATIONS
FREQUENT
• Calf pain or tenderness, or both
• Swelling with pitting oedema
• Increased skin temperature and
fever
• Superficial venous dilatation
• Cyanosis can occur with severe
obstruction
LESS FREQUENT
• Phlegmasia alba dolens,
• Phlegmasia cerulea dolens, and
• Venous gangrene.
• These are clinical spectrum of
the same disorder.
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13. CLINICAL MANIFESTATIONS
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14. DIAGNOSTIC STUDIES
• Clinical examination alone is able to confirm only 20-
30% of cases of DVT
• Blood Tests The D-dimer
• Imaging Studies
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15. CLINICAL TESTS
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16. IMAGINING STUDIES
INVASIVE
• venography,
• radiolabeled fibrinogen
NON-INVASIVE
• ultrasound,
• plethysmography,
• MRI techniques
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17. VENOGRAPHY
• It detects thrombi in both calf
and thigh
• It can conclude and exclude the
diagnosis of DVT when other
objective testings are not
conclusive.
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18. VENOGRAPHY
ADVANTAGES
• It is useful if the patient has a
high clinical probability of
thrombosis and a negative
ultrasound.
• It is also valuable in
symptomatic patients with a
history of prior thrombosis in
whom the ultrasound is non-
diagnostic.
DIS-ADVANTAGES
• It can primary cause of DVT
in 3% of patients who
undergo this diagnostic
procedure.
• An invasive and expensive.
• Although Venography was
once considered the gold
standard for diagnosis of
DVT, today it is more
commonly used in research
environments and less
frequently utilized in clinical
practice.
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19. RADIOLABELED FIBRINOGEN
• Because the radioactive isotope
incorporates into a growing
thrombus, this test can
distinguish new clot from an old
clot.
• Nuclear medicine studies done
with I125- labeled fibrinogen .
• More commonly used in
research.
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20. PLETHYSMOGRAPHY
• Principle- Blood volume
changes in the leg lead to
changes in electrical resistance.
• Venous return in the lower
extremity is occluded by
of a thigh cuff, and then the cuff
is released, resulting in a
decrease in calf blood volume.
Any obstruction of the proximal
veins diminishes the volume
change, which is detected by
measuring changes in electrical
resistance (impedance) over the
calf
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21. NON-INVASIVE
ULTRASONOGRAPHY
• Color-flow Duplex scanning is the
imaging test of choice for patients
with suspected DVT
• inexpensive, noninvasive,
• widely available
• Ultrasound can also distinguish other
causes of leg swelling, such as tumor,
popliteal cyst,abscess, aneurysm, or
hematoma.
MRI
• It detects leg, pelvis, and
pulmonary thrombi and is 97%
sensitive and 95% specific for
DVT.
• It distinguishes a mature from
an immature clot.
• MRI is safe in all stages of
pregnancy.
• Test may not be appropriate for
patients with pacemakers or
other metallic implants, it can
be an effective diagnostic
option for some patients.
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MANAGEMENT

24. MEDICAL
• Measures for preventing or reducing blood clotting within the vascular system are
indicated in patients with deep vein thrombosis.
• Unfractionated heparin: administered subcutaneously to prevent development
of DVT, or by intermittent or continuous IV infusion for 5 days to prevent the
extension of a thrombus and the development of new thrombi.
• Low-molecular-weight heparin (LMWHs): Subcutaneous LMWHs that may
include medications such as dalteparin and enoxaparin are effective treatments for
some cases of DVT; they prevent the extension of a thrombus and development of
new thrombi.
• Oral anticoagulants: Warfarin is a vitamin K antagonist that is indicated for
extended coagulant therapy.
• Factor Xa inhibitor: Fondaparinux selectively inhibits factor Xa.
• Thrombolytic therapy: Unlike heparins, catheter-directed thrombolytic therapy
lyses and dissolves thrombi in at least 50% of patients.
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27. PHYSIOTHERAPY
ASSESSMENT
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28. DEMOGRAPHIC DATA
• Name:-xyz
• Age/gender:-advance age
• Occupation:-mostly sedentary lifestyle
• Date of addmission:-
• Date of operation:- in operated cases
• Date of discharge:-
• Date of examination:-
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29. • VITAL SIGNS:-
 RR-
 PR-
 BP-
 HR-
 SP02-
 HEART SOUND-
• CHIEF COMPLAIN:-
 Pain & swelling of back of the lower leg.
 Warm skin in the affected area.
 Red skin color of the affected area.
 Pain at walking
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30. HISTORY OF PRESENT ILLNESS
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31. • Past medical history:-chronic predisposing modifiable and non-
modifible risk factors.
• Past surgical history:-
• Family history:-of venous thromboembolism
• Surgical notes:-
 Immobilization for prolong period.
 Insertion of intra-vascular device.
• Personal history:-
 Maybe altered due to pain.
 B/b may be inserted catheter.
 Habits:-smoking
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32. PAIN ASSESMENT
• Site:-
• Side:-
• Type:-thrombing cramp like pain
• Onset:-gradual
• Duration:-since immobiliztion period
• Intensity:-vas
• At rest & during activity no pain maximum pain
• Aggrevating factor:-standing or walking
• Reliveing factor:-
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33. ON OBSERVATION
• Posture:-tightness of affected muscles.
• Swelling:-of affected muscles.
• Redness:- of affected muscles.
• Gait: antalgic gait
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34. ON PALPATION
• Tenderness:- of affected area.
• Swelling:- of affected area.
• Temperature:-increase localized temperature of affected area.
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35. ON EXAMINATION
• Girth measurement of calf muscle in figure of 8 manner.
• Range of motion
1. Knee that is flexion and extension
2. Ankle that is df,pf,eversion,inversion
• Manual muscle testing
1. Knee that is hamstrings and quadriceps
2. Ankle that is tibilis anterior and calf muscle
• Special test
1. Homans sign : calf pain at df of foot
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37. ICIDH2
1. Body structure
A. Direct:dvt
B. Indirect:swelling ,redness
2. Body function
A. Direct:abnormal venous return, pain, decreased rom and muscle strength
B. Indirect:gait, posture
3. Activity limitation and participation restriction: proper weight
bearing, adl
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38. PFD
• A 50+ OLD PATIENT HAVING PAIN,SWELLING,TIGHTNESS OF
MUSCLE,ANTALGIC GAIT,IMPAIRED ROM,STRENGTH ASSOSITED WITH
DEEP VEIN THROMBOSIS
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39. PHYSIOTHERAPY MANAGEMENT
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40. GOALS
SHORT TERM GOALS
• To counsel the patient.
• To reduce pain and swelling.
• To increase range of motion.
• To increase muscles length.
• Early ambulation after surgery
LONG TERM GOALS
• To reduce swelling or oedema
• Increase muscle strength
• Cardiopulmonary endurance
• Do’s & don’ts
• Ergonomics advice
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41. TO COUNSEL THE PATIENT
• Educate the patient about the condition.
• Explain its prognosis.
• Ask him to do regular exercises to prevent pulmonary embolism.
• Ask to do exercise at regular interval while travelling or doing the
work at prolong static posture.
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42. TO REDUCE PAIN AND SWELLING
• Ice-pack at the affected area:-
• 15 minutes
• 3-4 times per day
• Elevate the affected area while sleepin or doing rest.
• Don’t keep your legs hanging while doing work.
• Wear gratuated compression stockings creating gentle pressure that
keep blood cooling and clotting.
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43. TO INCREASE RANGE OF MOTION
• Active ankel toe movement.
• Ankle pumping. In case of lower limb
• Active knee flexion & extension
• Wrist flexion & extension.
• Wrist ulnar & radial deviation.
• Elbow flexion & extension.
• Early ambulation in case of major surguries or stroke.
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44. TO INCREASE MUSCLES LENGTH
• To strech the affected muscle
 Example:- for calf muscle
1. Gastrocnemius-supine potion
Procedure:-cradle the foot and stretch the muscle with
full knee extension
2. Soleus-supine position
Procedure:-cradle the foot and stretch the muscle with
30` knee flexion.
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47. TO INCREASE MUSCLES STRENGTH
• Actively:-
1. Gastrocnemius:-one leg standing position with two fingure support on table.
Do knee flexion & extension with knee full extension.
2. Soleus:-one leg standing position with two fingure support on table. Do knee
flexion & extension with knee 30` flexion.
• With resistance
1. Manual:-give resistance in every ankel and knee movement
2. Elastic-resistance:-use theraband & theratube for every ankle & knee
movement
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50. TO REDUCE SWELLING & OEDEMA
• Intermittent pneumatic compression is a therapeutic technique use in
medical device that include air-pump & inflatable auxiliary sleeves,
gloves in a system design to improve venous circulation in limbs of
patient who suffer dvt.
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52. TO INCREASE MUSCLES STRENGTH
• Manual, mechanical & elastical resistance with increases its resistive
capacity.
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53. CARDIOPULMONARY ENDURANCE
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54. DO’S
• Do exercise regularly
• Elivate your leg while sleeping or
resting.
• Wear stockings
• Take walks
• Use ice pack
• Drink plenty of fluid
DONT’S
• Avoid hanging your legs
• Avoid wearing tight socks
• Don’t do massage as it break and loose
blood clots and travrl to unwanted
areas of body like heart or lungs
causing a fatal heart attack or a
blocked artery
• Avoid coffee and alcohol as it will
dehydrate us and makes veins
narrower and blood thicker so more
likely to get clot
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55. ERGONOMICS
• Do exercise on regular intervals.
• Use proper foot-rest.
• Don’t hang your legs.
• Use leg ergometer
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