Our Summary

Thoracic outlet syndrome is a condition that occurs when the nerves or blood vessels in the upper shoulder area get compressed. This can happen due to repeatedly using the upper limbs. Researchers have found that musicians who play string instruments like the violin or viola can suffer from this, due to the repetitive nature of their practice. In this study, the authors talk about five elite musicians - three violinists and two violaists - who developed this condition after years of intense practice. They were all successfully treated with surgery that involved removing the first rib, making a cut in the scalene muscles in the neck, and relieving the pressure on the nerves in the brachial plexus (a network of nerves that send signals from the spinal cord to the arm and hand). After surgery, all patients were able to go back to their musical careers. This is the first time such a condition has been reported in musicians who play string instruments. Doctors should consider this syndrome when treating musicians with upper limb issues.

FAQs

  1. What is thoracic outlet syndrome and how can it impact musicians who play string instruments like the violin or viola?
  2. What kind of surgical treatment is available for musicians diagnosed with thoracic outlet syndrome?
  3. Can musicians resume their careers after undergoing surgery for thoracic outlet syndrome?

Doctor’s Tip

A doctor may advise a patient undergoing thoracic outlet syndrome surgery to follow post-operative care instructions carefully, including physical therapy exercises to help regain strength and flexibility in the affected area. It is important for the patient to communicate any persistent symptoms or concerns to their healthcare provider to ensure proper healing and recovery. Additionally, the patient should be mindful of their posture and ergonomics to prevent future strain on the affected area.

Suitable For

Patients who are typically recommended thoracic outlet syndrome surgery are those who have not responded to conservative treatments such as physical therapy, medication, and lifestyle modifications. Patients who have severe symptoms such as pain, weakness, and numbness in the upper extremities, as well as those who have neurovascular compression causing significant impairment in daily activities, may be candidates for surgery. Additionally, patients who have a clear anatomical cause of thoracic outlet syndrome, such as a cervical rib or fibrous band, may also be recommended for surgical intervention. In some cases, patients who have a high-performance occupation or hobby that involves repetitive use of the upper extremities, such as musicians, may also be considered for surgery if their symptoms are impacting their ability to perform.

Timeline

Before thoracic outlet syndrome surgery:

  • Patient experiences symptoms such as pain, numbness, tingling, and weakness in the upper extremities
  • Patient may have tried conservative treatments such as physical therapy, medications, and lifestyle modifications
  • Diagnostic tests such as imaging studies and nerve conduction studies may be performed to confirm the diagnosis
  • Patient may be referred to a specialist for further evaluation and treatment options

After thoracic outlet syndrome surgery:

  • Patient undergoes surgical treatment including first rib resection, scalenectomy, and brachial plexus neurolysis
  • Patient may experience post-operative pain, swelling, and limited range of motion in the affected arm
  • Patient undergoes rehabilitation to regain strength and function in the affected arm
  • Patient gradually resumes normal activities and may be able to return to work or sports
  • Patient undergoes follow-up appointments with the surgeon to monitor recovery and address any concerns or complications.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with thoracic outlet syndrome surgery?
  2. How long is the recovery period after surgery and what is the expected outcome?
  3. Will physical therapy be necessary after surgery, and if so, for how long?
  4. How likely is it that the symptoms of thoracic outlet syndrome will improve or resolve after surgery?
  5. Are there any alternative treatments or non-surgical options that could be considered?
  6. How experienced are you in performing thoracic outlet syndrome surgery, and what is your success rate?
  7. Will I need to make any lifestyle or activity changes after surgery to prevent a recurrence of symptoms?
  8. How soon after surgery will I be able to return to playing my instrument (if applicable)?
  9. Are there any specific exercises or stretches I should do to help with my recovery and prevent future issues?
  10. What follow-up appointments or monitoring will be necessary after surgery?

Reference

Authors: Demaree CJ, Wang K, Lin PH. Journal: Vascular. 2017 Jun;25(3):329-332. doi: 10.1177/1708538116671064. Epub 2016 Sep 30. PMID: 27694556