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Dr Abdelaal and colleagues record the case of a man whose recurrent axillary vein thromboses were due to neuropathic arthropathy (December 2003, JRSM1). Thrombosis of the upper extremity is referred to as Paget–Schroetter syndrome.2 In 1875, Sir James Paget postulated that the cause of acute pain and swelling of the arm was spontaneous thrombosis of the veins draining the upper extremity.3 In 1884, von Schroetter was the first to relate the clinical syndrome to thrombosis of the axillary and subclavian veins.4 Paget–Schroetter syndrome is also referred to as `effort' thrombosis, because it occurs after unusually strenuous use of the arm and the shoulder.5 An anomaly at the thoracic outlet, such as compression of the subclavian vein between the first rib and a hypertrophied scalene or subclavian tendon, or between those two tendons themselves, is frequently found in affected patients.5 The prevalence of symptomatic upper-extremity deep vein thrombosis (DVT) was evaluated retrospectively at a community teaching hospital.6 It was diagnosed in 65 of 44 136 patients of all ages (0.15%). No patients developed symptomatic pulmonary embolism. Central lines at the site of thrombosis had been inserted in 39 of 65 patients; cancer was diagnosed in 30 of 65 patients (23 of the patients with cancer had central lines); and 19 patients had no apparent cause for their DVT. All patients had swelling of the upper extremities. Erythema over the affected site was present in 4 (6%); pain was present in 26 (40%), and all had discomfort from swelling.