Disclosures: Julio A. Martinez-Silvestrini, MD: Nothing to disclose

Case Description: 36-year-old female weightlifter with effort-induced thrombosis of her left upper extremity after competition.

Setting: Outpatient Sports Medicine Clinic

Patient: 36-year-old female developed left upper extremity (LUE) swelling 24 hours after a strongwoman competition. At the emergency room (ED) she was found with creatine kinase (CPK) of 499 U/L and creatinine of 1.2 mg/dL. Venous Doppler revealed no deep venous thrombosis (DVT), but slow vascular flow in the subclavian, axillary and brachial veins. On physical exam she had swelling without vascular changes. The diagnosis of rhabdomyolysis was made at the ED. Medications at home include ethinyl estradiol-levonorgestrel.

Assessment/Results: Subsequent magnetic resonance imaging revealed edema following the axillary and subclavian veins suggesting DVT. Follow-up Doppler revealed new thrombi at the lateral aspect of left subclavian, axillary and cephalic veins. 3 weeks later, she was found with painless LUE swelling of 2 cm circumference difference compared to her right arm, and congested superficial vasculature. Consulted to Vascular Surgery, was diagnosed with venous thoracic outlet syndrome and underwent venous thrombolysis and left axillary vein venoplasty. Post venoplasty she persisted with upper extremity numbness. Electrodiagnostic studies were normal.

Discussion: This patient illustrates a case of venous thoracic outlet syndrome, complicated by Paget-von Schroetter Syndrome or effort-induced deep vein thrombosis. Her modest CPK elevation and creatinine most likely were related to her physical exertion and post-workout dehydration, and not to rhabdomyolysis. She has no known genetic hypercoagulable state, yet her use of oral contraceptives increases her risk of thrombosis.

Conclusion: As weightlifting exercise and competitions increase in popularity, effort-induced thrombosis should be suspected in athletes with sudden limb swelling after workouts or competition. Specially should be considered in athletes in high risk groups, which include local trauma to the limb, and/or hypercoagulable state (endogenous or pharmacologic).

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/upper-extremity-effort-induced-venous-thrombosis-in-a-female-weightlifter/