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Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome
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Thoracic outlet syndrome affecting high-performance musicians playing bowed string instruments.

Christopher J Demaree1, Kevin Wang2, Peter H Lin1,3

  • 11 Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.

Vascular
|October 4, 2016
PubMed
Summary

Elite musicians playing bowed string instruments can develop thoracic outlet syndrome (TOS) from repetitive arm activity. Surgical treatment for TOS allowed all five musicians in this case series to return to their careers.

Keywords:
Thoracic outlet syndromemusiciannerve entrapment syndromestring instrumentviolaviolin

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Area of Science:

  • Orthopedics
  • Neurology
  • Music Medicine

Background:

  • Thoracic outlet syndrome (TOS) involves neurovascular compression in the upper shoulder.
  • Repetitive upper extremity activities are linked to musculoskeletal disorders in musicians.
  • Bowed string instrumentalists, like violinists and violists, are susceptible to these conditions.

Purpose of the Study:

  • To describe neurogenic TOS in elite bowed string instrumentalists.
  • To highlight the link between intense musical practice and TOS development.
  • To present surgical outcomes for affected musicians.

Main Methods:

  • A case series of five elite musicians (3 violinists, 2 violists) with neurogenic TOS.
  • Surgical intervention included first rib resection, scalenectomy, and brachial plexus neurolysis.
  • Assessment of post-surgical recovery and return to musical performance.

Main Results:

  • All five patients were diagnosed with neurogenic TOS.
  • All underwent successful surgical treatment.
  • Every patient was able to resume their professional musical careers post-surgery.

Conclusions:

  • This is the first report of TOS in high-performance bowed string instrumentalists.
  • Clinicians should consider TOS in string players with upper extremity pain.
  • Surgical intervention can be effective for TOS in this population, enabling return to music.