With treatment, prognosis would be excellent, vascular surgeons say
[[{"fid":"2338","view_mode":"default","fields":{"format":"default","alignment":"","field_file_image_alt_text[und][0][value]":false,"field_file_image_title_text[und][0][value]":false},"link_text":null,"type":"media","field_deltas":{"1":{"format":"default","alignment":"","field_file_image_alt_text[und][0][value]":false,"field_file_image_title_text[und][0][value]":false}},"attributes":{"height":845,"width":1200,"style":"height: 246px; width: 350px; margin-left: 6px; margin-right: 6px; float: left;","class":"media-element file-default","data-delta":"1"}}]]ROSEMONT, Illinois, March 12, 2019 – Professional athletes work extraordinarily hard to make it to the top, but sometimes that hard work can cause compression in the shoulder or upper arm, resulting in thoracic outlet syndrome (TOS) and its related symptom, deep vein thrombosis (DVT) in the upper extremity.
Los Angeles Lakers small forward Brandon Ingram, 21, is the latest to receive bad news about his arm. Reports this week say he has deep vein thrombosis (a blood clot in a vein) in his right arm and has been put on blood thinners to try to dissolve the clot.
When young athletes are diagnosed with upper extremity DVT, said Dr. Ali Azizzadeh, professor and director of vascular surgery at Cedars-Sinai in Los Angeles, the first diagnosis that should be considered is effort-induced thrombosis, which is also known as axillary-subclavian DVT from venous TOS. Details regarding Ingram’s actual diagnosis have not been released.
“An arm DVT in an athlete is frequently indicative of thoracic outlet syndrome,” said Dr. Azizzadeh, who has treated many athletes for the condition. “TOS usually affects the nerves that go to the arm but can also affect the vein.”
Thoracic outlet syndrome (TOS) is relatively rare condition that causes pinching or compression of the nerves or blood vessels leading to the arm. It is more common among people who use a lot of repetitive overhead arm movements. Thoracic outlet syndrome is usually treated by vascular surgeons, who are highly trained in disorders of the body’s circulatory system.
TOS periodically makes the news when a professional athlete (such as New York Mets pitcher Matt Harvey,) is sidelined for TOS surgery to repair compression on the nerves, veins and/or arteries in that area. Medication to dissolve the clot is standard treatment for a condition like Ingram’s, Dr. Azizzadeh said, but if the condition is part of thoracic outlet syndrome, many patients also need surgery to make more room for the vein to drain blood from the arm.
“The syndrome can occur from overuse, when repetitive arm motion causes either the vein or the artery to get pinched as it passes under the collarbone,” Dr. Azizzadeh said. “And with all that motion, the blood vessel gets scarred and that can lead to a clot.” In some cases, the athlete needs part of a rib removed, which could be in the way of the drainage system that moves blood from the arm, under the rib and into the heart.
“As we learn more about this disease (effort induced thrombosis),” added Dr. Deepak Nair, a vascular surgeon with Sarasota Vascular Specialists in Florida, “trainers counsel athletes on their form to avoid repetitive, severe, overhead motion. Athletes need to learn about decreasing overhead repetitions, avoiding weightlifting above the shoulder, and resting the arms below the horizontal.”
The good news for promising young athletes like Ingram is that their prognosis is usually great, Dr. Azizzadeh said.
Though the Lakers have announced that Ingram is out for the remainder of the season, if he has TOS and does need vascular surgery, he is likely to join a large group of TOS alumni who have made a complete recovery and resumed their athletic careers.
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The Society for Vascular Surgery® (SVS) is a not-for-profit professional medical society, composed of specialty-trained vascular surgeons and professionals, which seeks to advance excellence and innovation in vascular health through education, advocacy, research and public awareness.
EDITORS: When effort-induced thrombosis occurs in a vein in young active people, it is also known as Paget-Schroetter syndrome.