History

A history of trauma will be obvious in many cases, although pathological fractures may occur with little trauma. Reflex sympathetic dystrophy may follow trauma, e.g. Colles’ fracture. Congenital lymphoedema of the arm is rare; however, secondary lymphoedema is not and a history of carcinoma of the breast, operations on the axilla or radiotherapy to the axilla should be sought. There may be a history of a puncture wound or flea bite, suggesting cellulitis or lymphangitis. Streptococcal cellulitis is common following puncture wounds in patients who already have lymphoedema of a limb. Axillary vein thrombosis may come on after excessive or unusual exercise and has been nicknamed ‘effort thrombosis’. An example is a patient who has been painting a ceiling who is not used to doing that sort of thing. It may occur in patients with cervical ribs or thoracic inlet obstruction. Thrombosis may also occur following insertion of a central line.