Upper extremity deep venous thrombosis (UEDVT) is a thrombus within the subclavian, axillary or brachial vein. UEDVT is much less common than it’s lower extremity counterpart, but is associated with similar complications including: post-thrombotic syndrome, recurrent thrombosis, and rarely, pulmonary embolism. Thrombosis of the upper extremity is divided into primary and secondary causes; primary UEDVT occurs spontaneously in the setting of strenuous upper extremity effort or in the absence of known thrombotic risk factors. Secondary UEDVT is related to a known risk factor such as malignancy or central venous catheters [1,2].

The thoracic outlet is bound by the clavicle and subclavius muscle anteriorly, the scalenus anticus muscle laterally, the first rib posterior-inferiorly and the costoclavicular ligament medially. Compression of the neurovascular bundle within the thoracic outlet is termed thoracic outlet syndrome (TOS) and is present in approximately 60% of patients with UEDVT [1]. Effort-induced thrombosis, or Paget-Schroetter syndrome, is a clinical manifestation of TOS caused by distortion and narrowing of the vein within the tunnel by repetitive upper extremity exercise. Historically, Paget-Schroetter syndrome has been associated with unusual pursuits or occupations including: golf, tennis, baseball, football, weight lifting, painting, etc. [3] A literature review of recent case reports reveals UEDVT associated with baseball, surfing, and weight lifting [4-6]. Per Urschel and Razzuk, the preferred treatment for Paget-Schroetter syndrome is thrombolytic therapy followed by prompt resection of the first rib for neurovascular decompression [3]. However, surgery is not without its risks (e.g. pneumothorax, nerve injury, etc.) and no randomized controlled trials have been performed to investigate the optimal treatment of UEDVT [1].

This is the first report of the development of effort-induced thrombosis of the upper extremity following the use of an increasingly popular, modified, oscillating dumbbell.