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Case Report: Thoracic Outlet Syndrome in an Elite Archer in Full-draw Position

  • Case Report
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

One possible pathomechanism of thoracic outlet syndrome (TOS) is shoulder abduction and extension inducing backward motion of the clavicle which causes compression on the brachial plexus. This position occurs during the full-draw stage of archery, by drawing and holding the bowstring.

Case Description

A 28-year-old elite archer presented with a feeling of weakness and dull shoulder pain, and experienced decreased grip power and hypoesthesia in the ulnar nerve dermatome in the full-draw position. On CT angiography, the cross-sectional area of the subclavian artery in the costoclavicular space decreased to 40% compared with that of the subclavian artery in a noncompressed state. This patient had first rib resection through the supraclavicular approach with a clavicle osteotomy. At 3.5 years postoperatively, the patient maintained his job as a professional coach and did not have any specific complaints when teaching and demonstrating archery skills.

Literature Review

A literature review revealed numerous causes of TOS, ranging from congenital abnormalities to repetitive postures related to sports activities. The abduction and external rotation (ABER) position (shoulder at 90° abduction and external rotation) has been suggested for detecting TOS and is a documented cause of compression of the brachial plexus and subclavian vessels. We present the case of an archer with TOS association with repeated use of the ABER position.

Purpose and Clinical Relevance

TOS should be suspected when athletes repeatedly use shoulder extension and abduction for their sports if other pathologic conditions can be ruled out.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Konkuk University School of Medicine, Hwayang-dong, Gwangjin-gu, Seoul, South Korea

    Jin Young Park MD, PhD, Kyung Soo Oh MD, Hyun Yul Yoo MD & Jun Gyu Lee MD

Authors
  1. Jin Young Park MD, PhD
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  2. Kyung Soo Oh MD
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  3. Hyun Yul Yoo MD
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  4. Jun Gyu Lee MD
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Corresponding author

Correspondence to Kyung Soo Oh MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. 

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the reporting of this case report, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Park, J.Y., Oh, K.S., Yoo, H.Y. et al. Case Report: Thoracic Outlet Syndrome in an Elite Archer in Full-draw Position. Clin Orthop Relat Res 471, 3056–3060 (2013). https://doi.org/10.1007/s11999-013-2865-2

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  • DOI: https://doi.org/10.1007/s11999-013-2865-2

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