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Case report: Thoracic outlet syndrome in an elite archer in full-draw position.
[thoracic outlet syndrome]
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
.
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
.
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
.
TOS
should
be
suspected
when
athletes
repeatedly
use
shoulder
extension
and
abduction
for
their
sports
if
other
pathologic
conditions
can
be
ruled
out
.
Diseases
Validation
Diseases presenting
"shoulder abduction"
symptom
inclusion body myositis
thoracic outlet syndrome
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