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Andrew Korson 05-31-2013 05:41 AM

Effort Thrombosis (blood clot) in the arm and Crossfit.
I was recently diagnosed with an an effort thrombosis, also knows as Paget-Schroetter Syndrome, in my left arm. It is an unusual type of deep vein thrombosis (blood clot) caused by strenuous, overhead activity that occurs in young athletes. Essentially the vein that runs through the thoratic outlet between the clavicle, first rib, and scalene muscles becomes compressed, causing damage to the vein and eventually a clot. It is caused by the thoratic outlet being smaller than usual, hypertrophy of the scalene muscles, or a combination of the two.

My doctors think it was actually kicked off by power washing my house my house with a 30 foot long extension wand. The next day I started to feel some tension in my left forearm and over the course of the week this tension began to worsen. My armpit began to hurt quite a bit. The veins there, and on my arm, started to become quite visible and I had bruising on my bicep. Eventually I decided that it wasn't a standard sports injury and took myself to the ER where they did an ultrasound, revealing the clot. I am now on blood thinners and I will be for the next 3-6 months.

My options for treatment are:

1. Blood thinners for 3-6 months, let my body eat up the clot by itself, and stop training my shoulder area (permanently) allowing my scalene muscles to shrink back to their "normal" size and hopefully prevent reoccurrence.

2. Have thrombolysys (clot busting surgery) followed by removal of my first rib(s) to make more room in my thoratic outlet and prevent reoccurrence.

3. Blood thinners for 3-6 months, let my body eat up the clot by itself, and have my first rib(s) removed to prevent reoccurrence.

For various reasons my doctors are now recommending #1.

Although crossfit wasn't the "cause" of this problem there is no question that it was a contributing factor. That said, I don't blame this on crossfit per se as it could have happened with any other training regimen that caused hypertrophy of my scalene muscles. I've been crosfitting for about 2 1/2 years now and it's been one of the best things I've ever done for myself mentally and physically. Before that I was pretty sedentary. Now I've now been told that a huge chunk of what we do is out. I can go run a marathon, but nothing overhead. Specifically, no pull ups, rope climbs, handstand pushups, rowing, or shoulder presses. Presumably this extends to cleans, kettle bell swings (above eye level), snatches, jerks, etc, etc. One surgeon told me not to do deadlifts either although I'm not quote sure why. The doctors opinions differ as to whether these restrictions are temporary or permanent...

So... After all of that my question is.. Has anyone out there dealt with this? If so, when were you able to go back to training, if at all? My coach says he can find substitutions for me but it seems pretty tough when you cut out SO many elements. I can't believe I was getting big pr's in my snatch and c&j the week before this happened and it was using a pressure washer that got me....

I've posted this under injuries because my doctor has actually described it to me as a type of sports "injury".

Sean Rockett 06-02-2013 05:22 PM

Re: Effort Thrombosis (blood clot) in the arm and Crossfit.
I had a patient with this before, pretty rare compared to leg DVTs, He did not have surgery and it never came back although he was not doing overhead lifting.

Jonah Lyall 06-05-2013 10:43 PM

Re: Effort Thrombosis (Paget-Schroetter Syndrome) and Crossfit.
Hi Andrew

I had the exact issue happen to me in March last year (from weight training) and I had unfortunately left the problem for a couple of weeks by which time my arm from shoulder to fingers was swollen. Also went for an ultra sound and the doctor, although he could not pick up any shoulder injury luckily had a bad feeling about it and referred me to a specialist that day. By 2pm that day I was in surgery where they did a thrombolectomy (hope I have the correct spelling and term!) as the subclavian vein was completely occluded from the collar bone to mid bicep. I was very fortunate that they were able to clear a path through and get the blood flowing again.

I have been on blood thinners since then and hopefully will be able to get off them soon.

I have changed my routines from using to weights to body weight but at much higher intensity and I actually feel better than I ever have. I must admit that I do use weights for legs and I also do pull ups. I try to incorporate HIIT and active rest (such as doing burpees between sets) into the structure of my programs.

I have not had good guidance around what I can and can't do so if you have had any further advice please let me know.

Chris Carroll 07-08-2013 11:28 AM

Re: Effort Thrombosis (Paget-Schroetter Syndrome) and Crossfit.
Andrew and Jonah,

Any update on your condition?

I too have been diagnosed with Paget-Schroetter Syndrome and its attributed to crossfitting. I am still occluded despite blood thinners and am awaiting 1st rib resection surgery to relieve the compression of the subclavian vein. Unfortunately, I am not a professional baseball pitcher so am on a long list of other patients awaiting vascular surgery. In the meantime, I look like the fiddler crab with that enormous single claw. LOL

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