Paget-Schroetter syndrome or effort thrombosis is a rare condition with potentially severe consequences, affecting young and otherwise healthy athletes. Its classic clinical presentation should be rapidly identified to promote early diagnosis and treatment. This prevents recurrences and long-term complications such as persistent swelling of the affected arm. In a 1-year period we saw two young male athletes with this condition. One was treated conservatively and the other surgically, with vastly different outcomes. We therefore present their cases as well as a review of relevant literature to emphasise treatment of this rare condition.