Pain Management for Vein Conditions Producing Orthopedic Leg Pain
Vein Conditions Producing Orthopedic Leg PainAdmin2021-08-13T13:01:38-04:00
The cause of orthopedic leg pain can be musculoskeletal, neurological, or vascular. The focus of this article is on vein conditions that cause leg pain (venous insufficiency). Vascular leg pain management can require medical intervention at a vein clinic specializing in minimally invasive procedures to repair and optimize the function of your veins.
The term “vascular” is from the Latin word for a hollow container. Any condition affecting the vascular system is considered vascular disease, which can lead to tissues not getting enough blood (ischemia), as well as other serious, even life-threatening, problems.
As people age, problems can develop in their veins. In fact, one in three Americans over the age of 45 has some kind of vascular disease. Early symptoms may be minor and treated at home; however, they can become more serious, and even life-threatening if not treated by a vein specialist. Severe or persistent pain can indicate a more serious condition, which is why it is important to be aware of symptoms and seek medical attention at the earliest sign of a problem.
To understand the causes of orthopedic leg pain, it is important to understand diseases that affect the body’s veins.
Veins are flexible, hollow tubes with flaps inside, called valves. The valves open when the muscles contract, moving blood through the veins. When the muscles relax, the valves close, keeping blood flowing in one direction through the veins.
If the valves inside the veins become damaged, they may not close completely, allowing blood to flow “backward” (retrograde). When the muscles relax, the valves inside damaged veins are not able to hold the blood, resulting in pooling of blood or swelling in the veins. The pooling and swelling cause the blood to move more slowly through the veins which may cause the blood to stick to the sides of the vessel walls and form blood clots.
When the walls of a vein become damaged, blood collects and flows backward (retrograde) when the muscles relax, causing a pressure buildup in the vein. The buildup causes additional stretching of the veins, increased swelling, more valve incompetence, sluggish blood flow, and the potential for a blood clot to form. If left untreated, this condition can lead to various inflammatory disorders collectively known as venous disease that can lead to leg (or arm) pain.
The inflammatory process that causes a blood clot to form and block one or more veins is called thrombophlebitis, which most often occurs in the legs. A blood clot forms when conditions cause the blood to coagulate or become a solid, jelly-like mass. When a blood clot forms inside a blood vessel (thrombus), there is the potential for it to dislodge and travel through the bloodstream.
When thrombophlebitis occurs, it is possible for a blood clot to cause deep-vein thrombosis, pulmonary embolism, heart attack, or stroke. The causes of thrombophlebitis include trauma, surgery, or prolonged inactivity.
Some of the more common venous diseases include:
Superficial Thrombophlebitis. The inflammation of a vein near the surface of the skin in an extremity (especially the legs) that occurs in response to a blood clot in the vessel. It is a relatively minor disorder that causes red and tender veins.
Deep-vein Thrombophlebitis. A serious condition that may first have less-pronounced symptoms (half of all cases have no symptoms). However, it carries the risks of a pulmonary embolism (when a clot detaches from the vein and travels to the lung) and chronic venous insufficiency (impaired outflow of blood through the veins). The condition results in dermatitis, increased skin pigmentation, and swelling. A large embolism can be fatal.
Buerger’s Disease. A rare disease that most often affects the small and medium-sized arteries and veins in the arms and legs. The veins swell and may develop clots, cutting off blood supply to the feet, toes, hands, or fingers. These body parts will hurt, even when resting. With severe blockages, the tissue may die (gangrene) and require amputation. Superficial vein inflammation and symptoms of Raynaud’s occur commonly in patients with Buerger’s Disease.
Chronic Venous Insufficiency (CVI). A condition that occurs when the venous wall and valves in the leg veins are not working efficiently, making it difficult for blood to return to the heart from the legs.
May-Thurner Syndrome (MTS). A condition that occurs when the left iliac vein is compressed by the right iliac artery, which increases the risk of deep-vein thrombosis (DVT) in the left extremity. Together, these left and right iliac veins drain blood from the pelvis and lower limbs.
Peripheral Artery Disease (PAD). Like the blood vessels of the heart (coronary arteries), peripheral arteries (blood vessels outside the heart) can develop a build-up of fat and cholesterol deposits, called plaque, on the inside walls (atherosclerosis). Over time, the build-up narrows the artery causing less blood to flow. A blockage in the legs can lead to leg pain or cramps with activity (claudication), changes in skin color, sores, ulcers, and feeling tired in the legs. Total loss of circulation can lead to gangrene and loss of a limb.
Popliteal Entrapment Syndrome. A rare vascular disease affecting the legs of some young athletes. The muscle and tendons near the knee compress the popliteal artery, restricting blood flow to the lower leg and possibly damaging the artery.
Raynaud’s Phenomenon (Raynaud’s Disease or Raynaud’s Syndrome) A condition that causes the small arteries of the fingers and sometimes the toes to twitch or cramp when the patient becomes cold or excited. It can temporarily shut down blood supply to the area, making your skin look white or bluish, and feel cold or numb. The symptoms might be related to working conditions or underlying diseases, including lupus, rheumatoid arthritis, and scleroderma.
Spider Veins. Small red or purple clusters of tiny blood vessels that develop close to the surface of the skin, and have the appearance of a spiderweb.
Varicose Veins. Enlarged, swollen, and twisting veins that bulge from pools of blood in them, often appearing blue or dark purple.
Causes of Vein Conditions That Produce Orthopedic Leg Pain
Blood is meant to circulate through the body. If blood becomes stagnant, there is a potential for it to form a harmful clot.
Under normal conditions, blood constantly forms microscopic clots in the veins that are routinely broken down by the body. However, should the natural clot formation/clot breakdown balance become altered, harmful clotting may occur.
Peripheral arterial disease (PAD) can cause leg pain due to poor circulation. Without treatment, it can be fatal. The primary symptom is intermittent cramping pain in the leg that is induced by exercise, typically caused by obstruction of the arteries (claudication). Intermittent claudication causes the blood supply to the leg muscles to become restricted. The resulting lack of oxygen and nutrients causes pain. The cramps consistently occur after walking, and often ease upon resting.
Deep-vein thrombosis (DVT) is a blood clot in the deep veins of the leg that causes pain. It can emerge after spending an extended period of sitting. Symptoms of swelling and hot, painful sensations may occur only when the patient walks or upon standing up. The clot may dissolve on its own, but if the patient experiences dizziness and sudden shortness of breath, or begins coughing up blood, emergency attention is needed. These could be signs that DVT has developed into a pulmonary embolism (a blood clot in the lung).
A clot (thrombus) can form, if one or a combination of the following situations occurs.
Prolonged travel and sitting, such as long airplane flights, car, or train travel.
Hospitalization, which is common among bedridden patients (such as heart patients and those who have undergone any major or orthopedic surgery, especially of the hip or knee).
Trauma to the lower leg with or without surgery or casting. It can also be caused by intravenous catheters or needles, chemotherapeutic agents, or infectious organisms.
Pregnancy (including 6-8 weeks post-partum after delivery of the baby) and varicose veins are associated with a higher risk of superficial thrombophlebitis.
Conditions that may cause the blood to coagulate faster than normal (hypercoagulability)
Taking certain medications such as oral contraceptives and other estrogens.
Having a genetic or hereditary predisposition to clot formation.
Having an increased production in the number of red blood cells (polycythemia).
Trauma to a vein.
Fracture of a leg or arm.
Bruised leg or arm.
Complication of an invasive (surgical) procedure of the vein.
Deep-vein thrombophlebitis associated with a number of different cancers.
Vascular leg pain can overlap with neurological and musculoskeletal pain. Vascular problems can be serious. However, both PAD and DVT can be present with only mild symptoms or no symptoms at all. Anyone whose lifestyle or medical history leaves them prone to vascular problems in the legs should be aware of possible symptoms.
Symptoms of Vein Conditions That Produce Orthopedic Leg Pain
Several types of vascular disease can cause orthopedic leg pain. The signs and symptoms vary depending on the underlying cause. Generally, the symptoms include pain, swelling, and tenderness.
Erythromelalgia is a rare peripheral vascular disease where the syndromes include burning pain, increased temperature, erythema, and swelling. The condition affects the feet, and less commonly affects the hands.
Peripheral Artery Disease (PAD) happens when plaque builds up in the arteries supplying blood to the arms and legs, causing the arteries to narrow or even become blocked. The symptoms include leg weakness and numbness, hair loss on the legs and feet, and muscle pain when walking or climbing stairs (claudication).
Buerger’s Disease is due to small blood vessels that inflame and swell, vessels then narrow or become blocked by blood clots. The symptoms include intermittent pain in the legs and feet or arms and hands, inflammation along a vein just below the skin’s surface due to a blood clot, and painful and open sores on toes and fingers. The fingers or toes turn pale when exposed to cold (Raynaud’s Disease).
Raynaud’s Disease is a rare peripheral vascular disorder that constricts the peripheral blood vessels in the fingers and toes when the person is cold. The symptoms include cold and numbness in the toes and fingers, color change in the skin in response to cold or stress, and a prickly feeling or stinging pain upon warming or the relief of stress.
Varicose Veins: enlarged, swollen, knotted clusters of purple veins; edema (swelling in the legs); aching or a sensation of heaviness in the legs; itching skin above the affected veins; skin discoloration and ulcers on the inner aspect of the ankles (in advanced cases).
Superficial thrombophlebitis: a red, engorged, cordlike vein, associated with localized swelling, pain, or tenderness.
Deep-vein thrombophlebitis: generalized swelling, warmth, and redness in the affected limb; enlargement of superficial veins; bluish skin color in the limb or toes (cyanosis); and rarely, fever and chills. Post-thrombotic syndrome can occur after a deep-vein thrombosis. The affected leg or arm can become chronically swollen and painful with skin color changes and ulcer formation around the foot and ankle.
Patients may have several of these symptoms, or have no symptoms at all. In some cases, the symptoms may mimic a bacterial infection of the skin and tissues beneath the skin (cellulitis).
Diagnoses of Vein Conditions That Produce Orthopedic Leg Pain
Doctors can usually diagnose superficial thrombophlebitis based on the patient’s medical history and a physical examination. Deep-vein thrombophlebitis is harder to diagnose, so further tests may be required.
A venous duplex examination, a type of imaging test, can determine how efficiently the veins are returning blood to the heart. The test also detects blood clots in the legs. A small ultrasound imaging device placed on the skin over the major veins in the legs allows the technician to “see” the veins and listen to the flow of blood.
Risk classification tools can help decide whether a DVT is likely. If the probability of a leg thrombosis is low, a D-dimer blood test may be necessary. D-dimer is a chemical the body produces when a blood clot gradually dissolves. A negative result in this test, in most cases, means no blood clot exists. However, a positive D-dimer test result does not necessarily mean that a deep-vein thrombosis is present, since many situations can produce a positive result. Any bruise or blood clot will result in a positive D-dimer outcome (for example, after surgery or a fall, from cancer, or pregnancy). For that reason, D-dimer testing is used selectively.
Ultrasound is the standard method for diagnosing the presence of a deep-vein thrombosis. The ultrasound can help determine whether a clot exists, the location, and how large it may be.
In the past, healthcare professionals would perform simple tests on patients in an effort to diagnose a blood clot in the legs. However, they were not effective. One such test was to pull the patient’s toes toward the nose (Homans’ sign). Another test involved squeezing the calf to produce pain (Pratt’s sign). Today, doctors and health care professionals usually do not rely upon these to diagnose a DVT.
Venography is another test that is not usually performed anymore, which involved injecting dye into the veins to look for a thrombus.
Treatment of Vein Conditions That Produce Orthopedic Leg Pain
Physicians treat thrombophlebitis in various ways. Treatment options include:
If superficial thrombophlebitis is the diagnosis, doctors recommend the patient be up and active. The patient should also be checked frequently to make sure the blood clot does not progress. Doctors also recommend:
Anti-inflammatory medications (such as ibuprofen or naproxen).
Some patients with deep-vein thrombophlebitis may require hospitalization, though many are seen on an outpatient basis. Bed rest and elevation of the affected limb are essential. Doctors usually prescribe intravenous anti-clotting medication (such as heparin) for seven to ten days. Outpatients are given anti-clotting oral medications.
Clot-dissolving agents or anticoagulants (sometimes called “blood thinners”) can help resolve the condition. An anticoagulant treats, prevents, and reduces the risk of blood clots breaking off and traveling to vital organs of the body. (The term “blood thinner” is not strictly correct, because the medication does not actually thin the blood, rather it is an anticoagulant that prevents or reduces coagulation of blood, prolonging the clotting time.)
Special elastic support stockings (compression therapy) may be helpful in aiding circulation in the lower limbs.
A doctor may implant a small filter in the main vein of the abdomen to prevent clots in the legs from reaching the lungs.
Stents (a tubular support placed inside a blood vessel to aid healing or relieve an obstruction) may also be required to keep a vein open and prevent clotting.
An inferior vena cava filter is placed in the major vein that collects blood from both legs (inferior vena cava) to prevent blood clots from reaching the heart and lungs. These filters may be effective but have the potential risk of being the source of a new clot formation.
Surgery is a rare option in treating large deep venous thrombosis of the leg in patients who cannot take blood thinners, or who have developed recurrent blood clots while on anti-coagulant medications. The surgical procedure usually includes placing an IVC (inferior vena cava) filter to prevent future clots from traveling to the lungs.
The recommended length of treatment for an uncomplicated DVT is three months. Depending upon the patient’s situation, underlying medical conditions and the reason for developing a blood clot, a longer duration of anticoagulation may be required. At three months, the patient should be evaluated for the potential of future blood clot formation.
It is important to mention that patients taking anticoagulation medications have an increased risk of bleeding. The decision to use these medicines must balance the risk and rewards of the treatment, which should be discussed with your doctor.
Prevention of Vein Conditions That Produce Orthopedic Leg Pain
Precautions can be taken to help prevent blood clots and vein diseases that lead to orthopedic leg pain. To reduce the risk factors for developing blood clots:
Avoid or quit smoking (especially if also taking birth control pills or hormone therapy).
When traveling on a long trip, get up and walk every couple of hours.
Engage in moderate exercise, as recommended by a doctor.
Manage healthy blood sugar levels, cholesterol, and lipids.
Keep blood pressure under control.
Eat a healthy diet.
If you are being treated for a cardiovascular or other condition, follow the doctor’s orders carefully.
Conditions that place a person at a higher risk of orthopedic leg pain due to vein conditions include:
Being immobile, including prolonged bed rest due to illness or injury.
Taking birth control pills or hormone replacement therapy.
Surgery that damages the veins in an arm or leg.
Having a family history or genetic predisposition to forming blood clots.
Orthopedic leg pain has many different causes, and the symptoms often overlap. If symptoms persist, seek medical treatment.
Novus Spine & Pain Center
Novus Spine & Pain Center Vein Clinic in Lakeland, Florida specializes in treating orthopedic leg pain. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.