Objective: To emphasize the importance for health care professionals to be knowledgeable of a relatively rare form of thoracic outlet syndrome, known as Paget Schroetter syndrome. The etiology, key signs and symptoms, and the importance of immediate referral are highlighted and an introduction to manual therapists' role within a multidisciplinary team is provided., Clinical Features: Healthy athletes aged 15-30 are most commonly affected with 60-80% of patients reporting a history of repetitive or vigorous overhead activity prior to symptom onset., Intervention and Outcome: Manual therapists have a role in recognizing, referring, and providing symptomatic relief with soft tissue therapy, correcting abnormal biomechanics, manipulations, mobilizations, and a rehabilitative program, as seen in this case report., Conclusion: Early recognition and referral of Paget Schroetter syndrome are essential for optimal recovery. Manual therapists may prove to have a role in decreasing the need for surgical decompression and accelerating resumption of regular activities.