Superficial vein thrombosis of the upper extremity after pectoralis major repair: An uncommon complication

Background: Superficial venous thrombosis (SVT) is traditionally considered a benign condition, yet recent evidence indicates there may be a clinically significant overlap with it and deep venous thrombosis (DVT) and/or pulmonary embolism (PE) in a significant proportion of cases. Despite the well-established low incidence of venous thrombo-embolism (VTE) following upper extremity orthopaedic procedures such as pectoralis major (PM) tendon repair, thrombotic complications remain clinically noteworthy and potentially serious. Case presentation: A 43-year-old active male presented with left shoulder pain following a skiing accident, and he was diagnosed clinically with a complete PM tendon rupture. Surgical repair was performed uneventfully eight weeks after injury without pharmacologic thromboprophylaxis, consistent with guidelines for low-risk upper extremity surgeries. Ten days postoperatively, the patient developed a painful, cord-like swelling along the ipsilateral cephalic vein. Duplex ultrasound confirmed an isolated thrombosis within the cephalic vein extending proximally along the arm. The patient was initiated on therapeutic anticoagulation with rivaroxaban, resulting in rapid symptomatic improvement and an uncomplicated recovery. Conclusion: This case underscores the importance of maintaining clinical vigilance for superficial vein thrombosis even in surgical contexts considered low risk for VTE. Prompt imaging to differentiate SVT from DVT is crucial, and anticoagulation therapy may be warranted in cases involving extensive superficial thrombosis or proximity to deep venous systems. Appropriate patient education, timely recognition, and tailored treatment strategies are key steps toward ensuring optimal outcomes.