Symptoms and Physical Findings

Abstract

The Paget–Schroetter syndrome refers to a sudden thrombosis of the subclavian vein, which is usually associated with physical exertion of the arm due to the patient’s occupation or sport activities (Fig. 12.1). The name of the syndrome was given by the physicians who described this syndrome, namely, Paget in England and Von Schroetter in Austria [1–3]. Hughes must be credited with bringing this entity to the clinical knowledge and to label it most properly as we know it today [4, 5]. Typically the patient affected with acute thrombosis of the subclavian vein presents her/himself to the emergency room or to the physician’s office complaining of sudden pain in the affected arm as well as swelling and some bluish discoloration of the entire arm. Most often this episode is associated following a sudden effort with the arm. Occasionally the patient has had several episodes in the past that have resolved spontaneously with rest, until finally a very acute severe event takes place that prompts the patient to seek medical attention. The syndrome usually affects young people leading active and productive lives. The occurrence of thrombosis of the vein is often directly related to their occupation or sports activity. Among the sports leading to cause this syndrome are swimming, climbing, weight lifting, tennis playing, and others. Occupations that lead to the occurrence of this syndrome vary, but usually are laborers involved in strenuous physical activity with their arms with repetitive movements particularly over the head maneuvers. The physical findings at the time of the examination show usually severe edema of the arm particularly between the elbow and the shoulder, but it may also involve the forearm and the hand and fingers (Fig. 12.2a, b). The entire upper extremity may have bluish discoloration along with this edema. The radial pulse usually is always present and there are no signs of ischemia.