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Diagnostics 2018, 8(1), 11; https://doi.org/10.3390/diagnostics8010011

A Prospective Evaluation of Duplex Ultrasound for Thoracic Outlet Syndrome in High-Performance Musicians Playing Bowed String Instruments

1
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
2
Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
3
Department of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA
4
Department of Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
5
Univesity Vascular Associates, Los Angeles, CA 90024, USA
6
Department of Surgery, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
*
Author to whom correspondence should be addressed.
Received: 26 December 2017 / Revised: 19 January 2018 / Accepted: 22 January 2018 / Published: 25 January 2018
(This article belongs to the Special Issue Diagnosis and Treatment of Thoracic Outlet Syndrome)
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Abstract

Thoracic outlet syndrome (TOS) is a neurovascular condition involving the upper extremity, which is known to occur in individuals who perform chronic repetitive upper extremity activities. We prospectively evaluate the incidence of TOS in high-performance musicians who played bowed string musicians. Sixty-four high-performance string instrument musicians from orchestras and professional musical bands were included in the study. Fifty-two healthy volunteers formed an age-matched control group. Bilateral upper extremity duplex scanning for subclavian vessel compression was performed in all subjects. Provocative maneuvers including Elevated Arm Stress Test (EAST) and Upper Limb Tension Test (ULTT) were performed. Abnormal ultrasound finding is defined by greater than 50% subclavian vessel compression with arm abduction, diminished venous waveforms, or arterial photoplethysmography (PPG) tracing with arm abduction. Bowed string instruments performed by musicians in our study included violin (41%), viola (33%), and cello (27%). Positive EAST or ULTT test in the musician group and control group were 44%, and 3%, respectively (p = 0.03). Abnormal ultrasound scan with vascular compression was detected in 69% of musicians, in contrast to 15% of control subjects (p = 0.03). TOS is a common phenomenon among high-performance bowed string instrumentalists. Musicians who perform bowed string instruments should be aware of this condition and its associated musculoskeletal symptoms. View Full-Text
Keywords: thoracic outlet syndrome; nerve entrapment syndrome; musician; bowed string instrument; violin; viola; cello thoracic outlet syndrome; nerve entrapment syndrome; musician; bowed string instrument; violin; viola; cello
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).
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Adam, G.; Wang, K.; Demaree, C.J.; Jiang, J.S.; Cheung, M.; Bechara, C.F.; Lin, P.H. A Prospective Evaluation of Duplex Ultrasound for Thoracic Outlet Syndrome in High-Performance Musicians Playing Bowed String Instruments. Diagnostics 2018, 8, 11.

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