Disclosures: Alan Stupnitsky, MD: No financial relationships or conflicts of interest

Case Diagnosis: 30-year-old female with left arm pain and paresthesia

Case Description: The patient presented with spontaneous, insidious left arm pain, and paresthesia for 3 months. Medical history includes remote left shoulder dislocation without complication. She was seen by rheumatology 6 months prior, diagnosed with Sjögren’s disease, started on apixaban and prednisone. Imaging demonstrated left internal jugular and subclavian deep vein thrombosis (DVT) near the clavicle. Work-up included EMG, MRI of brain and cervical spine that were unremarkable. The patient endorsed dull, aching left shoulder pain that was moderate in intensity with weakness and numbness radiating down the left arm that involved the entire hand. Symptoms were exacerbated with overhead activities. Diffuse tenderness to palpation over left pectoral musculature. Bilateral shoulder range of motion was symmetrical and within normal ranges. Examination positive on the left for Tinel’s sign at pectoralis minor and elevated arm stress test. The patient was referred to physical therapy (PT) and referred to vascular surgery for concern for neurogenic thoracic outlet syndrome (TOS). MRA revealed severe narrowing of the left subclavian vein with arms abducted, not present with arms at her side. No evidence of thrombosis noted.

Setting: Outpatient Musculoskeletal ClinicAssessment/

Results: She completed PT for TOS with limited improvement in her symptoms. Due to lack of progress with activity modification and PT, she was referred to vascular surgery for consideration of subclavian vein decompression.

Discussion: Paget-Schroetter Syndrome, also known as “effort-induced thrombosis” is a form of upper extremity DVT that typically occurs in the axillary or subclavian veins of young, otherwise healthy individuals after reported vigorous activity. The incidence of this rare condition is 2.03 per 100,000 people and may be a presenting sequela of TOS.

Conclusion: Paget-Schroetter Syndrome is a rare condition that can present with activity related upper extremity DVT and TOS symptoms.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/upper-extremity-deep-vein-thrombosis-in-a-healthy-30-year-old-woman-a-case-report/