Blood clots caused by the obstruction of the veins located in the axilla or just below the collarbone are the cause of Paget-Schroetter's syndrome. The condition, prevalent in active males in their 30s, is also known as upper extremity deep vein thrombosis (UEDVT) or "effort" thrombosis and is caused by overexertion of the upper extremity muscles, mostly due to strenuous upper body exercise.
Causes and Clinical Signs
Named after British surgeon James Paget and Austrian internist Leopold von Schrötter, Paget-Schroetter's syndrome can occur due to anatomical predisposition or congenital abnormalities in the development of the shoulder and neck muscles. However, its most common cause is arduous arm activity, including weightlifting and martial arts. Of note is the case of British soccer player Gary Cahill, who suffered from a blood clot in his left arm after a training injury. Clinical signs and symptoms typically include dramatically swollen, heavy and painful arm with a blue appearance.
Mechanism of Disease
Extreme and repeated physical activity of the upper arm can cause muscle hypertrophy. In this situation, axillary veins can become narrow and compressed between the rib, the muscle and the collarbone, leading to severe inflammation and formation of blood clots.
Diagnosis, Treatment and Surgery
Paget-Schroetter's syndrome can be diagnosed by ultrasound to determine if a clot is present. Venograms are also used to observe blood flow within the veins and are the most accurate tests for clot and disease identification. Treatment options include anticoagulation therapy combined with thrombolysis to prevent future episodes. Decompression to release vein compression responsible for the clot formation can also be effective. It is believed that surgery, a method based on rib resection, may be the best method to repair the damage caused by the clot, although debates on timing are still ongoing. The procedure has been performed immediately after thrombolysis, but due to the potential damage to the veins caused by the treatment, waiting a few months before conducting the surgery may be preferable.
Impact on Quality of Life
Despite its rarity, Paget- Schroetter's syndrome is a painful and debilitating condition that can have profound consequences on the life of healthy and active individuals if ignored or not treated promptly. Despite the availability of treatment and surgery, long-term anticoagulation therapy and rehabilitative physiotherapy may be required for patients to regain full functionality of the arm.
References
- "Emergency Nurse"; Diagnosis and Management of Paget-Schroetter's Syndrome; S.D. Hart; October 2010
- "Vascular Medicine"; Paget Schroetter Syndrome; Ido Weinberg; January 2011
- UCLA Vascular Surgery: Paget Schroetter Syndrome
- "The Annals of Thoracic Surgery"; Surgery Remains the Most Effective Treatment for Paget-Schroetter Syndrome: 50 Years' Experience; H.C. Urschel and A.N. Patel; July 2008
- "The Journal of Vascular Surgery"; A Comprehensive Review of Paget-Schroetter Syndrome; K.A. Illig and A.J. Doyle; June 2010
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