Can anyone clarify me on whether there are differences in the kind of leg pain felt in DVT and simple muscle pain? I tried looking it up but the data varies. In one site it said that pain in DVT is felt when you flex. (So that means no aches when you’re just standing?) And follow up questions–ca you have multiple DVTs at the same time? Can DVT form in the buttock area?
Doctor Joshua’s Answer:
Differentiating the symptoms and signs of deep venous thrombosis from muscle pain, traumatic swelling and other such features is very difficult.
Reliable diagnosis of deep venous thrombosis can only be achieved with radiological examinations such as venography and ultrasound. Symptoms and physical examination may suggest a diagnosis, but are not sufficient for reliable diagnosis one way or the other.
Classical symptoms are pain and tenderness in the calf, and swelling of the leg/foot. This is usually one-sided.
Deep venous thrombosis can affect the veins going all the way up to the level of the hip, but the buttock area is not affected in such a way as to be noticeable by the patient. Buttock pain is generally not a symptom of DVT.
According to an article by Wells PS et al. (Lancet 1997;350: 1795-), a clinical model can be used to assess the probability of deep venous thrombosis in a patient. The main points are summarized here - I have modified the table to make it more understandable for non-medical persons, so this table is not to be used for diagnosis - it is only for patient education. For each clinical feature, points are added or deducted from the total score:
Clinical feature
Score
Active cancer (treatment ongoing or within previous 6 months)
1
Paralysis (weakness, disability) or recent plaster immobilisation of the legs
1
Recently bedridden for more than 3 days or major surgery within 4 weeks
1
Localised tenderness
1
Entire leg swollen
1
Calf swelling by more than 3 cm compared with the symptom-free leg (measured 10 cm below the knee)
1
Pitting oedema (swelling, pressing with finger leaves a dent, greater in the symptomatic leg)
1
Prominent superficial veins (clearly visible veins on the surface)
1
Some other diagnosis seems more likely
-2
If the total score is 0 or less, there is low probability of deep venous thrombosis. If the total score is 1-2, there is a moderate probability of DVT, and a high probability of DVT exists when the total score is 3 or more.
For instance, if a patient has cancer that’s being currently treated and his entire left leg is swollen, that brings the total score to 2, which means there is a moderate probability of deep venous thrombosis.
Also, if you have had a previous episode of deep venous thrombosis, are a smoker, are using birth control pills or other hormonal medication, or have been immobilized for a period of time just before the symptoms started (such as sitting in an airplane for many hours), the risk for developing deep venous thrombosis is increased.
The only way to diagnose DVT is to see the doctor and have the proper examinations done.
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