Neurogenic Thoracic Outlet Syndrome in Violinists and Violists: Playing-Related Biomechanical Considerations, Clinical Assessment, and Conservative Management—A Narrative Review

Background and Objectives: Violin and viola performance involves prolonged asymmetric cervical and shoulder-girdle postures and repetitive upper-extremity movements, which may increase mechanical loading of neural structures within the thoracic outlet. However, evidence regarding the biomechanics, clinical assessment, and conservative management of neurogenic thoracic outlet syndrome (nTOS) in violinists and violists remains limited. This narrative review aimed to synthesize the available evidence on performance-related biomechanics, clinical assessment, and conservative management of nTOS in these musicians. Materials and Methods: PubMed/MEDLINE, Embase, Scopus, Web of Science, and CINAHL were searched for English-language publications without date restrictions. The final search was conducted on 14 August 2026. Reference lists were screened, and targeted supplementary searches were performed to identify additional relevant literature. Results: Sustained cervical rotation and lateral flexion, upper-extremity elevation, and altered scapular alignment during performance may increase mechanical stress on the brachial plexus. Musician-specific reports have described scalene or subclavius hypertrophy associated with brachial plexus compression in violinists and violists. However, evidence regarding the diagnosis and conservative management of nTOS in this population remains scarce. Therefore, the broader nTOS literature was used to contextualize clinical assessment and rehabilitation. No single objective test is considered definitive for diagnosing nTOS, and both electrodiagnostic studies and provocative maneuvers have recognized limitations. Conservative management may include stretching, manual and soft-tissue interventions, neural mobilization, and exercises targeting scapular control. Conclusions: Prolonged performance-related postures and repetitive upper-extremity movements may increase mechanical loading on neural structures within the thoracic outlet, although a causal relationship with nTOS has not been established. Clinical assessment and rehabilitation should account for musician-specific biomechanics and symptom-provocation patterns; however, the effectiveness of proposed conservative interventions in violinists and violists remains uncertain. Prospective studies are needed to evaluate musician-specific diagnostic and rehabilitation strategies.