No Established Interrelation Between Type 1 Von Willebrand Disease and Recurring Trunk/Serratus Muscle Pain
There is no recognized association between type 1 von Willebrand disease (VWD) and recurring anterior lower trunk, latissimus dorsi, or serratus muscle pain. These conditions are unrelated based on the established clinical manifestations of VWD.
Clinical Manifestations of Type 1 VWD
Type 1 VWD presents with specific bleeding-related symptoms, not musculoskeletal pain:
- Mucocutaneous bleeding including easy bruising, nosebleeds, gingival bleeding, and menorrhagia in women 1
- Bleeding with surgical or invasive procedures including dental extractions 1
- Gastrointestinal or urinary tract bleeding 1
- Hematomas or hemarthroses (bleeding into joints), hemoptysis, and central nervous system bleeding in more severe cases 1
Type 1 VWD represents a partial quantitative deficiency of von Willebrand factor and accounts for approximately 75% of symptomatic VWD cases 1. Symptoms range from mild bleeding in Type 1 to severe, life-threatening bleeding in Type 3 VWD 1.
Why Musculoskeletal Pain Is Not a Feature
The pathophysiology of VWD involves deficiency or dysfunction of von Willebrand factor, which mediates platelet adhesion and aggregation at sites of vascular injury 1. This mechanism produces bleeding manifestations, not primary pain syndromes.
- Hemarthroses (joint bleeding) can occur in VWD and may cause secondary joint pain, but this is distinctly different from muscle pain in the trunk, latissimus dorsi, or serratus regions 1
- The NHLBI guidelines for VWD evaluation focus entirely on bleeding symptoms and do not mention musculoskeletal pain as a diagnostic criterion 1
Clinical Evaluation Considerations
If a patient presents with both Type 1 VWD and recurring trunk/muscle pain:
- These are coincidental findings requiring separate evaluation and management
- The muscle pain warrants investigation for musculoskeletal, neurological, or other systemic causes unrelated to the bleeding disorder
- Hematomas in muscle tissue from VWD could theoretically cause localized pain, but this would be associated with visible bruising, swelling, and acute bleeding episodes—not recurring isolated muscle pain 1
Important Caveat
While large hematomas can occur in VWD 1, recurring muscle pain without evidence of bleeding (ecchymoses, swelling, or acute bleeding episodes) should not be attributed to the VWD diagnosis and requires alternative investigation.