VARICOSE VEINS
In varicose veins there is a dilatation of the calibre of the veins and their valves are insufficient. The walls are irregularly thinned, lengthened and tortuous.
Osteopathic Etiology and Pathology.—The internal saphenous is the vein most frequently affected, although any vein throughout the body may become varicose. Commonly, varicose veins occur in the lower extremities and occasionally in the arms.
The valvular insufficiency is caused by stretching of the wall of the vein, thus separating the thin, free edges and leaving an interspace that allows regurgitation of the blood. The valves becoming insufficient, the column of blood in the veins has no support against gravity, and being interrupted in its course does not flow normally into collateral channels. The walls of the veins become thin, as does also the adjacent skin, thus increasing the danger of a rupture, either external or subcutaneous.
Varicose veins are most frequently found in females, following uterine enlargements. The condition may be due to any obstruction or constriction that prevents the free return of blood from the veins, such as dislocations of the hip, either slight or complete, dislocations of innominata, contractions of adductor magnus muscle affecting femoral vein, prolapse of diaphragm obstructing vena cava, tissue constrictions about the saphenous opening, garters, and, in fact, anything that might impede the free venous flow. The tendency to varicose veins increases as age advances, and many cases are found among people of middle life who have been accustomed to standing a great deal. Injuries to the pelvis, thigh or leg, lessening the nutrition to the leg, or injuries to the nerves, as vertebral dislocations in the lower dorsal or lumbar regions (the fourth lumbar especially) may be causes of varicose veins. Pregnancy or tumors in the abdomen or pelvis, causing pressure upon the iliac veins, are occasionally causes. Distention of the sigmoid flexure, causing pressure upon the left iliac vein, or distention of the cecum; pressing upon the right iliac vein, are fruitful sources, as are also diseases of the heart and lungs. Varicose veins of the upper extremities are due to occupations requiring overuse of the arms.
Complications.—Varicocele, hemorrhoids, labial varix in the female, varix over pubes, ulceration and eczema due to disturbances of nutrition, edema and thrombus.
Symptoms.—Lower Extremities.—Cramping pains in the limbs upon rising. Fullness and heaviness of the limbs. Inspection may reveal superficial varicose veins near the saphenous opening, upon the external thigh, in the popliteal space, upon the external leg or behind the ankles. Edema and congestion of the foot and ankles occur in a few cases. Pain is quite a prominent symptom, due to pressure upon the nerve fibres. Eczema and itching are due to disturbed innervation and blood supply to the skin. Ulceration may occur, due to the bursting of a vein.
Upper Extremities.—Before the varicosity appears there is usually pain or a feeling as of a sprain in the involved region of the arm. The pain is usually confined to a muscle or group of muscles.
Treatment.—The majority of cases are due to disorders about the pelvis, hip or thigh, and the treatment resolves itself into the removal of these obstructions or constrictions. Occasionally cases are caused by partial dislocations of the hip joint, which can be easily overlooked during a hurried examination. The slipping of an innominatum is an important factor. Rest in a recumbent position, attention to the general health, and especial attention to the bowels and liver, are essential in acute attacks. Occasionally the heart and lungs are at fault. Treatment twice per week should consist of removing any of the numerous causes of the condition, and spinal treatment as well; then the leg should receive special attention. Remember, thrombi may form and the vein must, under no circumstances, be touched in the treatment. Begin by carefully rotating the leg to stretch contracted tissue about the saphenous opening, then separate the tendons of the popliteal space and follow the course of the vein to the abdomen and relax tissue about it. Keep patient off the feet as much as possible and elevate the leg when sitting.
In rupture of varicose veins the hemorrhage can be arrested by elevating the limb and applying pressure with the fingers, above and below the wound, until a compress and bandage can be applied. The support of the varicose veins by elastic stockings will ease the pain and prevent edema in many cases, but, as a rule, it is a direct hindrance to the circulation on account of the necessity of having the stocking fit closely. Surgical operations are rarely indicated.
Phlebitis
(Phlegmasia alba dolens; milk leg)
An inflammation of a vein. In the condition described here it is a puerperal septic inflammation of the femoral vein. About the third week after confinement there is a swelling of the leg with or without redness. Great pain accompanies the condition and the temperature gradually rises to 102°-3°. As understood by osteopaths, this is the result of a partial closing of the saphenous opening during parturition so that the venous flow is partly stopped.
Treatment consists in carefully rotating the leg at the hip so that the fascia lata is spread, opening the lumen of the vein so the congestion will drain out. There will, also, probably be found innominate or lumbar lesions which must be adjusted with the result that almost immediate relief is given as a rule.
Chronic Phlebitis
The chronic form shows considerable inflammation along the line of the vein marked by tenderness, edema and thickening of tissue. The entire leg may be more or less involved through circulatory injury. In these cases will be found definite innominate lesions of a primary type or the distortion is superinduced by lumbar lesions. A few cases are quickly cleared up through adjustment that is readily secured. However, in others, there being considerable thickening of the sacro-iliac articulating tissues, some time may be required to get complete adjustment and consequent restoration of femoral circulation. In addition to this, careful abduction, flexion, hyperextension and circumduction is indicated. This last technique should be executed with great care and with due regard to pathology. If Dr. Still’s emphatic command were followed, that all maternity patients should have both legs rotated and innominates inspected, there would be no phlebitis cases, acute or chronic.