Tendon ultrasound in archers: Bakirci 2025 study

Using musculoskeletal ultrasound, the authors examined 20 entheses, the sites where tendons and ligaments attach to bone, in 87 Turkish athletes from seven sports and 49 sedentary people, for a total of 2,720 assessments. The athletes included 12 archers, the youngest in the sample (median age 19.5, half of them women), with a median of 9.5 years in the sport and a reported 60 hours of training a week.

In the archers' upper limbs the ultrasound inflammation score had a median of 3 against 0 in the sedentary group, and the damage score a median of 1 against 0, both with p < 0.001. In the lower limbs the archers did not differ from the sedentary group. Looking at individual lesions, the archers more often had a thickened supraspinatus, erosions and enthesophytes at that site, and thickening at the medial epicondyle and the triceps insertion. Across all sports, climbers carried the highest overall burden, in both arms and legs.

The study is cross-sectional, with one visit per participant. Athletes counted as elite if they were adults training more than 10 hours a week with at least five years in their sport; the controls were healthy adults with no sporting background. A rheumatologist experienced in ultrasound, unaware of each person's sport and clinical findings, used a 7 to 13 MHz linear probe to scan both sides at the supraspinatus and subscapularis insertions in the shoulder, the triceps and the common flexor and extensor origins at the elbow, the quadriceps and patellar tendon at the knee, and the Achilles tendon and plantar fascia at the foot. The images were scored after recruitment ended, anonymised, using the OMERACT definitions: hypoechogenicity, thickening and power Doppler signal make up the inflammation score; erosions, enthesophytes and calcifications the damage score, graded 0 to 3.

Sports were grouped by the limb used most: archery sits among the upper-limb-dominant sports and among those that do not load the lower limb. Comparisons used the Mann-Whitney test, chi-squared tests and linear regression with age, body mass index and training hours.

This is a preprint on Research Square that has not yet been through peer review, and it shows. The sample numbers do not match (8 basketball players in the text, 7 in the table), the text mentions hockey, which is not in the study, the make-up of the limb groups changes between the methods and Table 3, and the reference list contains duplicated entries and author lists that look generated in series. The 60 hours a week attributed to the archers, with an interquartile range of 60 to 60, are hard to accept as a measured figure.

As for the design, 12 archers are few, and the comparison is with sedentary people rather than with athletes from other sports of the same age. The archers were the youngest group, so age does not explain their differences, but sex and other factors are not controlled sport by sport. The scores add the two sides together, so it is not known whether the findings concern the bow arm or the drawing arm. The abstract says many athletes had no symptoms, yet the results contain no data on pain. And, as the authors acknowledge, a cross-sectional study cannot say whether these ultrasound signs are a harmless adaptation or the start of a problem.

The study suggests that in archers who train heavily, ultrasound of the shoulder and elbow often finds signs at the tendon insertions, especially the supraspinatus, even in a young group. For an archer having a shoulder scan this is worth knowing: in this small group of archers, thickening or small enthesophytes at the supraspinatus were not unusual, and what they mean is for the doctor to judge, together with symptoms and training history.

The study does not show that these signs lead to injury, that any particular volume of shooting is too much, or which arm is involved. With 12 archers, an unreviewed preprint and several errors in the data, it counts in the registry as a first signal about archers' shoulders, to be confirmed by studies that separate the two sides and follow athletes over time.