{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:38:47Z","timestamp":1787755127052,"version":"build-2784847793"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Update<\/jats:title>\n                    <jats:p>This article was updated on April 22, 2022, because of a previous error in the order of authors. The correct order is: Douglas K.H. Wong, MBBS(HK), Yat Wah Wong, MBBS(HK), FRCS(Ed), FHKCOS, FHKAM(Ortho), and Stephen W.K. Cheng, MBBS(HK), MS(HK), FRCS(Ed), FRCS(Eng), FHKCS, FHKAM(Surgery).<\/jats:p>\n                    <jats:p>An erratum (JBJS Case Connect. 2022;12[2]:e20.00984ER) has been published for this article.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case:<\/jats:title>\n                    <jats:p>A 34-year-old man spontaneously presented with bilateral thoracic outlet syndrome over 1 year. He was a gymnast active in rowing and weightlifting, with \u201cslanted\u201d shoulders, narrowed costoclavicular spaces, and well-developed scalene muscles. Imaging revealed fractures of multiple bilateral upper ribs in various degrees of nonunion. The patient's symptoms improved after activity modification and physiotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Atraumatic spontaneous rib fracture-nonunions are an uncommon cause of thoracic outlet syndrome; this diagnosis should be considered in physically active patients presenting with typical symptoms with atypical anatomy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.cc.20.00984","type":"journal-article","created":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T15:00:28Z","timestamp":1619017228000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Not All Gymnastic Exercises Are Suitable for Everyone: An Uncommon Cause of Thoracic Outlet 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