Primary Subclavian Venous Thrombosis Which Developed After Sleeping with the Arm in an Outstretched Position: Report of a Case

Abstract

Primary subclavian venous thrombosis is more rare than secondary thrombosis. This type of thrombosis is called "effort thrombosis" or Paget-Schroetter syndrome, and develops after a strenuous effort of the superior limb. A day after a 55-year-old man got drunk and slept in the left lateral position in combination with an abducted and elevated position of the left superior limb, he became aware of swelling and an oppressive feeling in his left superior limb and was admitted 9 days later. Thrombus of the left axillary-subclavian vein was confirmed by venography, and thrombolytic therapy with urokinase was performed immediately. The left arm symptoms improved for the most part. Venography after the therapy revealed thrombolysis at the site of the axillary vein, while the subclavian vein enhanced the collateral vessel pathway. The patient was discharged on the seventh hospital day, and anticoagulant therapy with oral warfarin sodium has since been continued. This is considered to be a rare case of subclavian venous thrombosis caused by sleeping in an abnormal position with the arm outstretched.

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“…Several movements other than those specifi c to sports, such as carrying a pack, scrubbing clothes for a long time, and sleeping with the arm outstretched have also been reported to cause thrombosis. 1,5 Push-ups are a common exercise done to develop and maintain muscle strength and endurance of the shoulders and arms and to address cardiopulmonary fi tness. This exercise is also done for shoulder rehabilitation by people with shoulder dysfunction or pain.…”

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“…But as I covered in my May column, effort thrombosis occurs in many diverse sports and activities. It can even occur after sleeping on an outstretched arm, after a bout of novel push-ups, or after just golfing every day for a week (2–4). It is ironic that effort thrombosis tends to occur on the right , but deep venous thrombosis of the leg tends to occur on the left , maybe in part because of May-Thurner syndrome (compression of the left common iliac vein by the right common iliac artery) which — to a greater or lesser degree — seems to be fairly common (5).…”

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“…Primary subclavian venous thrombosis (Paget-Schroetter syndrome) is the name that has been given to this entity [15]. This syndrome is also called effort thrombosis, stress thrombosis or venous thoracic outlet syndrome because it frequently develops after a strenuous effort of the superior limbs [16]. The subclavian vein runs through a small corridor that can be narrowed by an excessive abduction of the superior limbs, excessive cervical extension, and a backward expansion or dropping of the shoulders.…”