Key takeaways

  • UEDVT is a condition where a blood clot forms in a deep vein in the upper body, typically linked to medical devices like central lines or strenuous physical activity. It can cause serious complications if untreated.
  • Symptoms include swelling and pain, but it can sometimes occur without noticeable symptoms. Prompt medical attention is crucial if UEDVT is suspected to prevent complications like pulmonary embolism or stroke.
  • Treatment typically involves blood thinners, thrombolytics, or surgery, depending on the clot’s severity and location. Preventative measures focus on managing risk factors like maintaining movement and closely monitoring those with medical devices.

A deep vein thrombosis (DVT) occurs when a blood clot forms in a deep vein in your body. Upper extremity deep vein thrombosis (UEDVT) is a blood clot in a deep vein in your upper body, usually in the arm or neck.

If you’ve ever had to sit still for a long time, such as during a long airline flight, you may have heard about the risk of developing a blood clot in your leg and what to do about it. In different circumstances, it’s possible to develop this type of clot above your waist.

Blood clots can form when blood thickens and clumps together. If a blood clot forms, it’s possible for it to break off and travel through your bloodstream.

About 5% to 10% of all DVTs occur in the upper extremity.

Keep reading to learn about the symptoms of UEDVT and when to get help, how doctors diagnose and treat it, and measures you can take to prevent them.

The symptoms of a UEDVT can also be symptoms of other health conditions. Because of this, it can be hard to tell that you have UEDVT by the symptoms alone.

Sometimes, UEDVT has no symptoms.

Symptoms of UEDVT may include:

  • swelling of the arm or hand
  • shoulder pain
  • neck pain
  • bluish skin color
  • pain that travels to the arm or forearm
  • hand weakness

Many, but not all, people who develop UEDVT have a central venous catheter (also called a central line), like a port or PICC line.

It also occurs in those who may have Paget-Schroetter syndrome (PSS), a blood-clotting disorder that causes UEDVT that occurs in the dominant arm of younger people who participate in athletics that require repeated motion of the upper extremities.

If you experience symptoms of UEDVT, it’s important to get emergency medical attention to prevent serious complications.

UEDVT is considered a medical emergency, as a blood clot can potentially break off and travel to the lungs, brain, or heart. If you think you may have a blood clot, it’s best to get emergency medical attention at a hospital emergency room.

UEDVT is most common in people with a central line, so if you’re experiencing symptoms that may be UEDVT, it’s important to talk with your care team and get emergency care.

UEDVT has several possible causes:

Implanted devices above the waist

Medical procedures, such as having a central venous catheter, a catheter above the waist for dialysis, or a pacemaker, can increase the risk of UEDVT.

A central venous catheter is a thin, flexible tube inserted into a vein to deliver medication. A catheter for dialysis is inserted into the vein to filter blood when the kidneys cannot. A pacemaker is a medical device implanted under the skin to manage an irregular heartbeat.

All of these devices can potentially damage blood vessels during the insertion procedure or after, while they are working in your body. The presence of a foreign object in your vein can also restrict your blood flow, which is a risk factor for DVT.

Because another health condition leads to an EUDVT, this is a secondary cause.

Strenuous activity and PSS

Though rare, strenuous activity can cause a UEDVT. This is known as PSS, venous thoracic outlet syndrome (VTOS), or effort thrombosis.

This usually occurs in the dominant arm of younger athletes who regularly perform (or have a history of performing) activities that involve excess and repeated motion of the upper extremities, such as:

  • rowing
  • wrestling
  • swimming
  • gymnastics
  • sports involving repetitive ball throwing, like football, baseball, and basketball

These repetitive, strenuous activities can damage the inside coating of a blood vessel over time and cause a clot.

This is known as a spontaneous UEDVT, and it is a primary cause of UEDVT.

Trauma or whiplash

A fracture involving the humerus, clavicle, or ribs, or any trauma to the surrounding muscles, can damage nearby blood vessels.

This can result in a UEDVT.

Physical abnormalities

People who have a primary, or spontaneous, UEDVT due to strenuous activity may have an extra rib high in the chest or an abnormal muscle insertion.

An extra rib is known as a cervical rib. It’s harmless in most circumstances, but it can irritate a vein or nerves with repeated motion.

The extra rib may be visible on an X-ray, but sometimes, a doctor needs a CT scan to see it.

Thoracic outlet syndrome can also cause a UEDVT. If you have this condition, your rib compresses your blood vessels and nerves as they leave your chest and enter your upper extremity. It can develop from trauma or repetitive motions.

Blood clotting disorders

Certain conditions, including genetics, can cause blood to clot more than it normally should. When blood clots too much, it’s said to be in a hypercoagulable state.

Genetic causes may include conditions in which certain proteins involved in blood coagulation are deficient or abnormal.

Other medical conditions

A UEDVT may develop due to another medical condition, such as cancer or a connective tissue disorder, such as lupus. Occasionally, a doctor may diagnose a DVT related to a cancer before they find the cancer.

Sometimes, a secondary UEDVT can develop for no apparent reason.

People with a secondary UEDVT may be more likely to have conditions that cause blood to clot easily. Your doctor will look for other conditions linked with blood clotting in assessing your risk for a UEDVT.

Your doctor may use one or more of the following imaging tests to diagnose a UEDVT:

  • an ultrasound
  • a CT scan
  • an MRI

Some people may receive a diagnosis of UEDVT when they are treated for a complication of it.

Complications of UEDVT happen when a blood clot breaks free and travels to the lungs, brain, or heart. Blood clots that form in your calves or pelvis are more likely to break off and cause a PE than clots in other areas. But complications of clots in the neck or arms are still possible.

Complications of a UEDVT can include:

These complications are life threatening medical events and require emergency medical care. If someone has experienced a PE, stroke, or heart attack, contact 911 or your local emergency services.

Symptoms of a pulmonary embolism can include:

Symptoms of a stroke can include:

Symptoms of a heart attack can include:

A doctor can treat a UEDVT with the following:

Blood thinners

Doctors usually prescribe blood thinners (anticoagulants) for UEDVTs. These medications prevent blood clots from forming. Some blood thinners require periodic blood tests to check your clotting levels and make sure your dose is effective.

You usually also need to take certain precautions to avoid bleeding and injury while taking blood thinners. This can include:

  • not shaving with a straight razor
  • getting prompt medical attention for any head injuries
  • avoiding certain foods and drinks that may act as natural blood thinners

Common anticoagulant blood thinners include:

Newer anticoagulants with a reduced risk chance of bleeding complications include:

Your doctor may recommend that you continue to use a blood thinner for 3 to 6 months. This depends on the location and severity of the clot, whether you have a central line that can be removed, and the blood clot’s response to treatment.

Thrombolytics

Thrombolytics are drugs that can dissolve a blood clot. They are usually administered by a healthcare professional in one of two ways:

  • injected into your vein
  • through a catheter into your vein

The catheter method works best if your doctor uses it less than two weeks after the first symptoms arise. This method can increase the risk of serious complications, such as internal bleeding and bleeding in the brain. Doctors usually reserve it for situations in which the clot is causing life threatening complications.

Surgery

Doctors may recommend surgery known as thrombectomy for severe cases of UEDVT that lead to complications of stroke, heart attack, or pulmonary embolism (PE).

In surgery for UEDVT, a doctor can cut open a vein and remove the clot.

An alternative is to use a catheter to thread a balloon past the clot. When your doctor inflates the balloon, they may be able to drag the clot out of the vein.

Physical interventions are risky. Doctors mainly use them to treat severe UEDVTs.

Your doctor might use a combination of these approaches to treat UEDVT. The best approach will depend on:

  • your symptoms
  • your age
  • your general health
  • the age of the clot

UEDVT is a blood clot occurs in the upper body, usually the neck or arm. One common symptom is a swollen arm, but many people do not experience any symptoms.

UEDVT can result from damage to a vein that develops due to an injury, whether from a central line, trauma, or damage from repetitive stress over time. It can also develop because of structural differences or genetics.

If not treated, UEDVT can result in severe complications, including PE, stroke, and heart attack.

Doctors usually treat these blood clots with blood thinners, though the exact treatment plan can depend on the location, severity, and whether you’re experiencing complications.