Ultrasound finds more entheseal changes in the elite archer's arm than in sedentary people

The summary today

There is a single study, and it is a preprint in a venue with questionable editorial standards. With ultrasound of 20 entheses on each side, 12 Turkish elite archers show an upper-limb inflammation score with a median of 3 against 0 in 49 sedentary people, the highest of seven sports, ahead of climbing, and a damage score of 1 against 0 (p < 0.001 for both). The supraspinatus is thicker and shows more erosions and enthesophytes, and at the elbow the medial epicondyle and the triceps insertion are thicker. The map is selective, though: the lower limb looks like that of sedentary people, and the lateral epicondyle and subscapularis show no changes. Two major limitations remain. Twelve archers in one cross-sectional sample are few, and an image is not a diagnosis: the authors note that many athletes with marked changes have no symptoms. Because of the venue, moreover, the registry reports the study but does not use it to decide the status, which remains not studied.

Also phrased as: "entheseal ultrasound in archers"; "archer's shoulder tendons"; "enthesopathy in archery"; "supraspinatus in archers"

Evidence

• 2016
  Context Archers Published later

  16 wheelchair archers, 15 with a spinal cord injury, average age 45.6, 12 years of competing and 23.8 years of wheelchair use, ultrasound of both shoulders: on average 2.29 changes in the bow shoulder and 2.35 in the drawing shoulder, mainly tendinopathies of the subscapularis and supraspinatus on the bow side and of the long head of biceps on the drawing side, with no difference between sides. No sedentary group, tendons rather than entheses, and a shoulder that also pushes the wheelchair.

  Shoulder Disease Patterns of the Wheelchair Athletes of Table-Tennis and Archery: A Pilot Study · Byung-chun You, Won-Jae Lee, Seung-Hwa Lee, Sol Jang, Hyun-seok Lee

• 2025
  Context Archers Published later

  Venue with questionable editorial standards: this result does not count towards the status. 12 adult Turkish elite archers against 49 sedentary people, within a study of 87 athletes from seven sports; ultrasound of 20 bilateral entheses, 2,720 assessments in all. Upper-limb inflammation score, median (interquartile range): archers 3 (1.3-4.8) against sedentary 0 (0-1.5), p < 0.001, the highest of the seven sports, ahead of climbing 2 (1-4.8) and cycling 1.5 (0-3.3), with golf, handball and basketball at 0. It is a preprint.

  Sport-Specific Loading Drives Ultrasound-Detected Entheseal Adaptations in Elite Athletes Questionable venue · Sibel Bakirci, Tuba Melekoglu, Gufat Arslan, Seyyid Bilal Acıkgoz, Yilmaz Sungur, Sibel Zehra Aydin

• 2025
  Context Archers Published later

  Venue with questionable editorial standards: this result does not count towards the status. The same archers, structural damage: upper-limb damage score 1 (0-2.8) against 0 (0-0) in sedentary people, p < 0.001. The supraspinatus tendon is thicker (p = 0.001) and more often shows erosions (p = 0.036) and enthesophytes (p = 0.036); the frequencies are not given in the text.

  Sport-Specific Loading Drives Ultrasound-Detected Entheseal Adaptations in Elite Athletes Questionable venue · Sibel Bakirci, Tuba Melekoglu, Gufat Arslan, Seyyid Bilal Acıkgoz, Yilmaz Sungur, Sibel Zehra Aydin

• 2025
  Context Archers Published later

  Where changes appear and where they do not, in the upper limb: in archers the medial epicondyle (p = 0.009) and the triceps insertion (p between 0.011 and 0.048 according to the text) are thicker; the lateral epicondyle, on the other hand, is thickened only in athletics, cycling and climbing, and the subscapularis only in athletics and climbing, not in archers.

  Sport-Specific Loading Drives Ultrasound-Detected Entheseal Adaptations in Elite Athletes Questionable venue · Sibel Bakirci, Tuba Melekoglu, Gufat Arslan, Seyyid Bilal Acıkgoz, Yilmaz Sungur, Sibel Zehra Aydin

• 2025
  Context Archers Published later

  In the lower limb the archers do not differ from sedentary people: inflammation 0 (0-2) against 0 (0-1), damage 1 (1-5.8) against 2 (0-4.5), differences not significant. The changes follow the load of shooting rather than being widespread.

  Sport-Specific Loading Drives Ultrasound-Detected Entheseal Adaptations in Elite Athletes Questionable venue · Sibel Bakirci, Tuba Melekoglu, Gufat Arslan, Seyyid Bilal Acıkgoz, Yilmaz Sungur, Sibel Zehra Aydin

• 2025
  Context Archers Published later

  In the multivariable analysis, in the group of sports that load the upper limb (archers, golfers, basketball players, handball players, climbers), upper-limb inflammation is associated with age and weekly training hours, damage with age alone; the coefficients are in the supplementary material. The authors also note, without counts by sport, that many athletes with marked ultrasound changes have no symptoms.

  Sport-Specific Loading Drives Ultrasound-Detected Entheseal Adaptations in Elite Athletes Questionable venue · Sibel Bakirci, Tuba Melekoglu, Gufat Arslan, Seyyid Bilal Acıkgoz, Yilmaz Sungur, Sibel Zehra Aydin

Status history

1. 2016 Not studied An ultrasound study of the shoulders of 16 wheelchair archers, 15 of them with a spinal cord injury, examined on both sides, finds on average more than two changes per shoulder, mainly tendinopathies of the subscapularis, supraspinatus and long head of biceps, with no difference between the bow arm and the drawing arm. It looks at tendons rather than entheses, has no sedentary group, and in people who have used a wheelchair for twenty years the shoulder also works to push it. There is still no relevant evidence on the question: not studied.
2. 2025 Not studied The first direct comparison arrives: 12 Turkish elite archers against 49 sedentary people, 20 entheses examined on each side. In the upper limb the archers have the highest inflammation score of seven sports, a median of 3 against 0, and a damage score of 1 against 0, with a thicker supraspinatus and more erosions, and at the elbow a thicker medial epicondyle and triceps insertion. In the lower limb they do not differ from sedentary people, and the lateral epicondyle and subscapularis stay normal. One study, twelve archers and a preprint in a venue with questionable editorial standards: the registry reports it but does not use it to decide the status, which remains not studied.

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