Exercise-Induced Deep Vein Thrombosis of the Upper Extremity

Abstract

Paget-Schroetter syndrome or effort-related upper extremity deep vein thrombosis is a rare condition that usually afflicts young healthy individuals, most commonly males. The cause is multifactorial but almost always involves extrinsic compression of the subclavian vein at the thoracic inlet, causing venous stenosis from repetitive trauma. The diagnosis of this condition may be difficult, and its delay may contribute to potential complications including thrombosis progression, pulmonary embolism, thrombosis recurrence, and post-thrombotic syndrome. Similarly, the best therapeutic option has not been established and in the lack of evidence-based guidelines, treatment may be extremely challenging especially in children, in whom long-term complications can be particularly disabling.

Upper extremity deep vein thrombosis presenting to a chiropractic clinic: a description of 2 cases

“…6 The basilic vein drains the tissues of the upper limb into the axillary vein, which is joined by the cephalic to become the subclavian vein. 6 The subclavian vein crosses the first rib through a tunnel formed by the clavicle and subclavius anteriorly, the anterior scalene laterally, the first rib posteroinferiorly, and the costoclavicular ligament medially. 6,10 Repetitive mechanical compression is a common mechanism of injury to the vein, as it is frequently compressed while traversing this tunnel.…”

“…[1][2][3] Upper extremity deep vein thromboses are categorized as primary or secondary, and relate to UEDVT affecting the subclavian (18%-69%), axillary (5%-42%), or brachial (4%-13%) veins. [1][2][3][4][5][6][7] Approximately one-third of UEDVT s are primary in nature, which include idiopathic thromboses or effort-induced thromboses. 2,4 Effort or activity-related UEDVT are sometimes referred to as Paget-Schroetter syndrome (PSS).…”

“…5 It appeared to the physicians that vascular damage could occur in otherwise healthy individuals following repetitive upper limb stretching. 5 Paget-Schroetter syndrome has been classified as a disorder with many etiologies 1 ; however, it is most commonly induced via activity or physical effort 6 in young and otherwise healthy individuals. Therefore, it most commonly affects the dominant arm.…”

“…Therefore, it most commonly affects the dominant arm. 1,6,7 The purpose of this report of 2 cases is to describe the presentation of PSS to a chiropractic clinic, highlight the importance of prompt referral and imaging, and discuss the potential role for conservative therapy in the management of patients who may experience ongoing symptoms.…”

Exercise-Induced Deep Vein Thrombosis of the Upper Extremity

“…Delay in diagnosis and misdiagnoses may prevent prompt therapy, which may contribute to potential complications including thrombosis progression, recurrence, pulmonary embolism, and postphlebitic syndrome. In the earlier section of this article (part 1) [1], we have reviewed the literature in effort-related thrombosis of the axillary- subclavian vein, which is most commonly found in adults. No large prospective studies to access, classify, and describe the natural history of the disease, best methods of diagnosis, and most appropriate treatment have been carried out.…”