Thoracic outlet syndrome affecting high-performance musicians playing bowed string instruments

Thoracic outlet syndrome, a condition due to neurovascular compression in the upper shoulder region, can be caused by chronic repetitive activity of the upper extremities. Studies have linked upper extremity musculoskeletal disorders to high-performance musicians who play bowed string instruments such as the violin or viola. We report herein a case series of five elite musicians, including three violinists and two violaists, who developed neurogenic thoracic outlet syndrome following years of intense practice. Successful surgical treatment including first rib resection, scalenectomy, and brachial plexus neurolysis was performed in all patients. All patients were able to resume their musical career following surgical treatment. Our report represents the first description of thoracic outlet syndrome in high-performance bowed string instrumentalists. Clinicians should be aware of thoracic outlet syndrome as a differential diagnosis when treating string instrumentalists with upper extremity musculoskeletal ailments.