Interestingly, two shooters developed CTS in both hands, and all suffered from brachial plexus neuropathies at both sides, which implies that impact at the wrist of recoil is not the only cause. Maintaining the shooting position for a prolonged period likely leads to such results. This statement may be reinforced by the results of a study finding shooters to suffer from lower back pains as frequent as weight lifters proving this discipline to impact tissues at spine levels  significantly. Moreover, Ojanen et al.,  found shooting scores achieved in a standing position to be positively correlated with abnormalities of muscles' strength in the lower extremities and the upper body. These results were displayed on military field training; however, it can also be assumed that sport shooters to obtain high accuracy need to increase their posture muscles strength and overload tissues at spine levels.
However, we cannot exclude that extended arm can transfer enough force of recoil into the upper extremity's proximal levels and impact nerves also on the opposite side. There is also a possibility of long-lasting influence of inorganic lead fumes produced on shot to impact neuropathies' development due to its neurotoxic properties . The most plausible explanation of our results includes the combined impact of all the mentioned factors. However, the last one is least probable, since club members' shooting range seemed to be adequately ventilated.
We are aware of the limitations of our study: 1) examined group was relatively small and heterogeneous; therefore our results may to some degree originate from differences in anthropologic properties or lifestyle; 2) shooters used handguns predominantly, our results are not fully applicable to users of longer firearms; 3) shooters used handguns with different weight, handles, calibres and types of ammunition (rimfire and centerfire), which may affect their impact on the body.
The knowledge provided by this study can be applied in clinical practice by sports and military physician as well as the general practitioners to detect neuropathies before they lead to severe complications and hence a decrease in quality of life. Understanding that shooters are more likely to develop these types of injures, it would be sensible to find ways to alleviate some impact on nerves associated with this sport: it should be promoted to create the ergonomic workspaces and reinforce the healthy posture in their daily life. Moreover, it is possible that different types of handles in handguns differ in how they impact their user, and so creating the most ergonomic one may be beneficial in the context of prevention of neuropathies in the upper extremity. Interestingly, during military field training, standing shooting score achieved with a rifle was decreased in mid-training measurements, while the one scored in the prone position was not affected . Standing position may exert significant stress on a body, and thus alleviation of this effect should be achieved by training shooting sports in the prone position. The abovementioned study did not assess neurophysiological properties in upper extremities, and therefore its application is limited with regard to our paper.