Right Arm Pain And Swelling In A Competitive Swimmer - Page #4

Working Diagnosis:
Deep axillary vein thrombosis secondary to exertion (Paget­-Schroetter Syndrome) with possible exacerbation from a compression wrap.

Catheter directed thrombolysis with subsequent first rib excision.

She tolerated the procedures well and is on track to return to competition.

Author's Comments:
Compression banding is a common technique used in CrossFit competition. While no direct causality can be determined, banding may have contributed to the patient's thrombus.

Editor's Comments:
Paget-Schoetter syndrome describes an effort-induced thrombosis of the axillosubclavian vein. Thrombus formation in these patients is often associated with excessive upper extremity activity. (1)
These patients can be successfully treated with early diagnostic venography, thrombolysis, and paraclavicular thoracic outlet decompression. (2)
Repetitive positional compression of the axillary artery can also cause focal intimal hyperplasia, aneurysm formation, segmental dissection, and branch vessel aneurysms in overhead athletes. These lesions have a propensity toward thrombosis and distal embolism. Positional arteriography is used for diagnosis and these patients are treated surgically. (3)

1. Keisler, Brian D. MD; Armsey, Thomas D. II MD. Paget­-Schroetter Syndrome in an Overhead Athlete. Current Sports Medicine Reports. 4(4). August 2005, 217­219.

2. Spencer J. Melby, Suresh Vedantham, Vamsidhar R. Narra, George A. Paletta Jr,
Lynnette Khoo­Summers, Matt Driskill, Robert W. Thompson. Comprehensive surgical management of the competitive athlete with effort thrombosis of the subclavian vein
(Paget­-Schroetter syndrome), Journal of Vascular Surgery, 47.4, April 2008, 809­820.

3. Yazan M. Duwayri, Valerie B. Emery, Matthew R. Driskill, Jeanne A. Earley, Rick W. Wright, George A. Paletta Jr, Robert W. Thompson. Positional compression of the
axillary artery causing upper extremity thrombosis and embolism in the elite overhead
throwing athlete, Journal of Vascular Surgery. 53.5, May 2011, 1329­1340. References

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