Athletes are often viewed as the picture of health. But even those in peak physical condition can face serious vascular challenges. One condition that can affect young, otherwise healthy athletes is Thoracic Outlet Syndrome (TOS), a disorder that can restrict blood flow and lead to clot formation between the collarbone and upper ribs (or thoracic outlet).

At Cardiothoracic and Vascular Surgeons (CTVS), our vascular specialists are highly experienced in diagnosing and treating TOS, especially in athletes and active individuals.

Why Athletes Are at Risk for Blood Clots

You don’t need to have traditional risk factors like smoking, obesity, or a sedentary lifestyle to develop a blood clot. According to the American Heart Association, some blood clots in athletes may be caused by a condition called Paget-Schroetter syndrome—an effort-induced thrombosis that’s considered a type of vascular TOS. It typically affects younger people who are highly active.

Athletes, particularly those involved in sports that require repetitive arm motion such as baseball, swimming, tennis, or weightlifting, can develop clots due to stress and compression of the veins in the shoulder and upper chest. The repeated motion and hypertrophy of muscles in these areas may narrow or compress the space where major veins pass, increasing the risk of clot formation.

Understanding Thoracic Outlet Syndrome (TOS)

TOS occurs when the blood vessels or nerves in the space between the collarbone and first rib are compressed. In athletes, this compression is often caused by muscular development, repetitive motion, or anatomical variations that narrow the space.

There are two types of TOS:

  • Vascular TOS: involves compression of the blood vessels or arteries
  • Neurogenic TOS: affects the nerves in the brachial plexus

While neurogenic TOS is the most common, vascular TOS is particularly concerning in athletes because of the risk of deep vein thrombosis (DVT) in the upper extremity. A clot in this area can lead to long-term complications or, in rare cases, travel to the lungs and cause a life-threatening pulmonary embolism.

TOS symptoms can include:

  • Swelling or pain in the arm, shoulder, or neck
  • Heaviness or fatigue during activity
  • Blue or discolored fingers
  • Tingling or numbness in the hand or arm
  • A throbbing sensation near the collarbone

How CTVS Diagnoses and Treats TOS in Athletes

Our team uses advanced imaging tools such as duplex ultrasound and MRI to confirm a Thoracic Outlet Syndrome diagnosis and evaluate the severity of compression.

For athletes experiencing effort-induced blood clots due to TOS, treatment typically involves:

  • Physical Therapy to strengthen chest muscles
  • Medications to dissolve the clot and thin the blood
  • Surgical decompression, often including first rib resection, to relieve the anatomical cause of the compression and prevent future clots
  • Ongoing vascular surveillanceand return-to-activity guidance to ensure a safe and healthy recovery

The goal of treatment is to restore healthy blood flow, prevent long-term damage, and allow athletes to safely return to their sport.

When to Seek Care

If you’re an athlete and you’ve noticed swelling, pain, tingling or heaviness in the arm, shoulder or neck, especially after activity, it’s important to seek medical evaluation. Blood clots in athletes can be overlooked or misdiagnosed because symptoms often mimic muscle strain or overuse. If something doesn’t feel right, don’t wait. Prompt diagnosis and treatment with a vascular surgeon experienced in TOS is crucial to avoid complications.

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

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