Soccer player with unusual right shoulder and arm pain and swelling

Abstract

INTRODUCTIONPaget-Schroetter syndrome, or effort thrombosis, refers to a deep venous thrombosis in an upper extremity. It is most commonly located in the axillary or subclavian veins and is associated with vigorous repetitive movements and anatomic abnormalities. CASE PRESENTATIONThis case study describes an 18-year-old Division 1 soccer player who presented with worsening axillary swelling and pain. He was found to have subclavian stenosis at the level of the thoracic inlet between the clavicle and first rib, with deep venous thrombosis in his right axillary, subclavian, proximal brachial, and basilic veins. It was diagnosed with ultrasound and confirmed with venography. He was treated initially with enoxaparin and warfarin before having mechanical thrombolysis, balloon venoplasty, infusion of tissue plasminogen activator, and a right first rib resection. CONCLUSIONAs Paget-Schroetter syndrome is rare, early recognition and management leads to fewer long-lasting sequelae and less morbidity. Left untreated, it can result in pulmonary embolism and residual upper extremity obstruction.

Thoracic Outlet Syndrome in Sport: A Systematic Review

“…It seems that strength training (which is required in many sport preparation) is by itself a risk factor of TOS ( Basile et al, 2001 ; Roche-Nagle et al, 2007 ; Kellar and Trigger, 2014 ; Jourdain et al, 2016 ; DeLisa et al, 2017 ; Umana et al, 2019 ). This hypothesis is also supported by several case reports reporting TOS in several other sports with sometimes less involvement of overhead arm motion such as soccer ( Zakaria et al, 2020 ), cycling ( Smith et al, 2008 ), judo ( Ijaopo et al, 2016 ), running ( Leung et al, 1999 ), climbing ( Lutter et al, 2015 ) or triathlon ( Sancho-González et al, 2017 ). However, TOS is a rare condition, and its diagnosis implies the elimination of many and more frequent differential diagnoses and it also implies the evaluation of the existence of other risk factors such as coagulation disorder, predisposal anatomical factor or muscle hypertrophy.…”

Congenital, Acquired, and Trauma-Related Risk Factors for Thoracic Outlet Syndrome—Review of the Literature

“…Given these reports, the aforementioned sports can be confidently considered as a risk factor for nTOS, as the authors mentioned [82]. In the literature, we can also find single case reports of the occurrence of nTOS in athletes of other sports (with less overhead motion), such as soccer, cycling, judo, running, climbing, or triathlon, and the authors of these cases agree on the hypothesis that it may be related to the strength training required to prepare in these disciplines [85][86][87][88][89][90]. Beteck et al have not noted a difference in the effectiveness of treatment between the group of athletes and nonathletes [84].…”