Venous thoracic outlet syndrome is a relatively rare condition. One variety that is related to effort, often referred to as Paget-Schroetter syndrome, is seen more often in persons who are athletic or occupationally active. This condition can have significant morbidity if left untreated. Diagnosis is best undertaken with duplex ultrasound or venogram. The current standard for treatment includes catheter-directed thrombolysis with surgical correction of the thoracic outlet and subclavian vein with some variability of this depending upon the presentation. Some cases may require anticoagulation for approximately 12 wk. Return to play should be expected in successfully corrected cases that include a collaborative rehabilitation program.