For Michael Miskovich, an active 25-year-old, fitness is more than a hobby, it is his way of life. From mixed martial arts (MMA) and kickboxing to rigorous weightlifting, he pushes his body to the limit. But in December 2024, a slight shoulder tightness quickly took a serious turn, revealing a blood clot and a Thoracic Outlet Syndrome diagnosis.

A Rapid Onset of Symptoms

Michael had a history of shoulder injuries, including multiple broken collarbones and a torn tendon in his left shoulder that sidelined him for nearly eight months. But he had never experienced anything quite like what happened last December.

On December 11th, he noticed some tightness in his right arm, but nothing alarming. The next day, while flying to Florida to surprise his mother, his friend pointed out that his right arm looked swollen and discolored. By December 13th, his arm had turned purple and doubled in size. Concerned, his sister-in-law, a physician assistant, urged him to go to the emergency room immediately.

A scan at the hospital in Florida confirmed a blood clot was blocking the flow of blood to his right arm. Further imaging revealed two small pulmonary embolisms (PEs) in his lungs, meaning the clot had already started to break off and travel through his bloodstream—a dangerous and potentially fatal development.

Finding the Right Diagnosis

Despite these alarming findings, doctors in Florida weren’t sure of the root cause of the blood clots. It wasn’t until a physician with expertise in Thoracic Outlet Syndrome (TOS) recognized Michael’s condition that they had a clear diagnosis. TOS occurs when the blood vessels or nerves in the thoracic outlet, the space between the collarbone and first rib, become compressed, leading to pain, swelling, and in some cases, blood clots.

The doctor in Florida performed an emergency clot removal surgery, but Michael still needed further treatment to treat the underlying cause, TOS. His mother began researching thoracic outlet syndrome specialists and found CTVS board certified vascular surgeon Dr. Jeffrey Apple.

Thoracic Outlet Syndrome Surgery 

Michael returned to Austin in January 2025 to meet with Dr. Apple, who confirmed that his history of shoulder injuries and intense weight training, particularly overhead pressing movements, likely contributed to the development of TOS. Dr. Apple performed a thoracic outlet decompression surgery, helping to alleviate the compression in his shoulder and significantly reduce the risk of future clots.

His experience taught him a valuable lesson.

“Your health should be your number one investment,” says Michael. “If you have symptoms, don’t ignore them, get checked out and do your due diligence in finding a specialist who truly understands your condition.”

Though he’s taking time to let his body fully recover, he plans to return to MMA training in the future.

Blood Clot Awareness Month: Know the Signs

Michael’s story is a timely reminder during Blood Clot Awareness Month. Blood clots affect approximately 900,000 Americans each year, with many cases going undiagnosed until complications arise. 

For questions about our vascular, cardiac, or thoracic services, please visit ctvstexas.com or call us at (512) 459-8753 to schedule an appointment.

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