Has anyone heard of this?

[His High Holiness]

All;

Weird sitautions relating to umpiring cross my computer on an almost daily basis but the following is weirder than most.

We have only a couple of female umpires (out of 250) and a few weeks ago, one of them was doing a game and got hit in the thigh. (I believe that she is 49 years old.) We have all had those monster bruises, that over a period of weeks turn various colors before they disappear. The umpire got the monster bruise that we are familiar with but it did not just go away.

Medically, my understanding of what happens when we get hit by a baseball is that a vein or veins will rupture internally and then seal up with a blood clot so that we don't bleed to death internally. So far, so good. (If my medical understanding is incomplete or incorrect, would someone please correct it in their response.)

Several days later, this umpire was doing the plate and all of a sudden, she could not get her breath. What had happened was that the blood clot had broken loose. Veins go towards the heart and as they travel towards the heart, they join up with other veins and get larger and larger. Therefore, the clot had a free flow to the heart, without any problem. The clot passed through the valves and chambers of the heart without doing any damage, and then entered the arteries going to the lungs. Once it entered a lung, it started going into narrower and narrower channels where it eventually reached an artery too narrow to pass through and a blockage occurred. (This a called a pulmonary embolism.) This stopped the reoxygenation process in that portion of the lung and thus the sudden shortness of breath of the umpire.

The umpire was hospitalized for a week and will be on blood thinners for six months. Obviously, she cannot umpire during that time. Since then, I have heard that embolisms often result in death.

Has anyone else heard of umpires getting embolisms from the bruises that are a regular risk of our profession? Those thigh briuses are the most colorful, but I never knew that they could be fatal.

Peter

[Jeffrey A. Mathison]

Medically speaking, your characterization of the mechanism of a bruise is correct. The lining of the blood vessels, called endothelium, calls clot starters (platelets)to the site of damage (rupture) and the hole is sealed off. The larger the defect in the vessel lining, the larger the clot. Usually, these clots do not amount to much size and don't represent much of a threat. However, if they are above the knee and occur in a deep vessel (femoral vein)rather than a superficial vessel, we are at risk for a chain reaction clot formation to occur. Once the deep vein thrombosis (DVT) occurs, if not treated with anticoaggulation (heparin, coumadin, etc...), embolization can occur.

The best course of action to take for those "monster bruises" is to ice them down as quickly as possible and monitor for signs and symptoms of (DVT): increased pain, swelling, and increasing circumference of the thigh. If those symptoms occur, see you physician IMMEDIATELY!

Jeffrey A. Mathison, M.D.
Baseball Umpire

[Bfair]

Ok, Doc, what is the possibility of a clot forming, but not moving during the immediate period of injury. That leads to the question, if a deep thigh bruise occurred with no apparent embolism problem occurring thereafter, is there still risk that the clot could eventually move, relocate, and cause further problems months or even years later?

Years ago I dumped my motorcyle resulting a very deep thigh bruise and significant edema in the thigh that, according to my orthopoedic surgeon, was different than anything he had ever seen. Like some may get water on the knee, I had water on the thigh---draining off perhaps several quarts of fluid including blood. My thigh was like a very large water balloon and required several drainings separated over several months. I've also permanently lost most feeling in that thigh. What are the possibilities that a clot may have formed for which there could be further risk of relocation and subsequent problems?

Seeking free medical advice........
Please do not send any bills at this time..........
My credit is good---I owe everybody............


Freix

[glshapiro]

Some people are more at risk for DVT. Particularly females that are taking hormones such as estrogen or birth control pills.Obviosly, a very rare event. If swelling and pain in the leg do not resolve quickly after such an event a non-invasive ultrasound will usually show if a blood clot is present or not in the leg.

[Jeffrey A. Mathison]

Typically, the DVT (deep venous thrombosis) clot will form a couple of days to a week following the acute injury. It takes a while for the chain reaction I wrote about to occur. That's why we should ice down the deep thigh bruises and then watch for signs and symptoms for the next several days.

It appears that you had something similar to a compartment syndrome where the bruise, edema, and inflammation caused more fluid formation and had to be drained. Actually, the risk in your situation was one of permanent damage to the muscles and nerves rather than an embolic phenomenon. The compression of the deep vessels from all the swelling probably PREVENTED a DVT! I would say your risk of DVT now (several years later) is negligible.

All in all, it sounds like it wasn't much fun!

Thanks for the reply,

Jeff "Doc" Mathison

[Bfair]

Final question, Doc.

With the injury causing almost total loss of feeling in the thigh, is there likelihood that this will cause any type of accelerated atrophy during the aging process, or is it likely nerve damage that's done and over at this point?

Is this something that will come back to haunt me in the future?


Freix

[Jeffrey A. Mathison]

The way the body is wired up is really a miracle. The sensory nerves can be damaged and the motor nerves can be fully functional. I would have expected you to already have a significant degree of denervation atrophy if you were going to have it. Since you do not, I think you are just going to live life with a numb, but firm thigh!

Don't hesitate to ask anything else you want to, because I intend to pick your brain about baseball.

"Doc" Mathison

[Rog]

Great post "Bfair".
The responses by the medical persons are outstanding; and, much appreciated!!!!!
Knowing what inherent risks are involved in such injuries could prevent a tragedy.
Thanks to all of you.....